In 2023, tobacco was responsible for more than 68,000 deaths in France, representing 11% of all deaths recorded that year.
Behind the numbers are advanced-stage lung cancers, sudden heart attacks and respiratory insufficiencies that gradually diminish independence.
These statistics are particularly concerning given that France has implemented a structured anti-tobacco policy for over three decades, combining increases in cigarette pack prices, smoking bans in public places, plain packaging, and national prevention campaigns. Despite these measures, the health burden of tobacco remains substantial, and cigarettes continue to cause widespread mortality.
68,000 Deaths in 2023: A Major Health Impact
In its latest synthesis report, Santé publique France reviewed all national mortality data to measure the impact of tobacco. The findings are stark: more than 68,000 deaths in 2023 are attributable to smoking.
The term “attributable” refers, in epidemiology, to the number of deaths that would likely not have occurred without exposure to a risk factor—in this case, tobacco consumption. In other words, these deaths are statistically linked to cigarettes, whether they involve cancers, cardiovascular diseases, or chronic respiratory conditions.
Expressed as a proportion of all deaths recorded in France that year, this represents 11% of total mortality—one in nine deaths linked to tobacco.
Tobacco Use: A Well-Defined Population
Mortality Highly Marked Among Men
The report also highlights a significant difference between the sexes. In 2023:
- 16% of male deaths are attributable to tobacco
- compared to 6% of female deaths
This difference is largely explained by the history of tobacco use in France. Men began smoking heavily earlier, starting in the mid-20th century. Women followed later, particularly from the 1970s onwards. As tobacco-related diseases often appear after 20 to 30 years of exposure, this time lag partially explains the observed gap.
Still, the gap is gradually narrowing. For several years, lung cancer mortality among women has been increasing, a consequence of decades of female smoking.
An Unequal France in the Face of Tobacco
The report also highlights marked regional disparities. The Hauts-de-France, Grand Est, and Corsica regions have the highest mortality rates attributable to tobacco… because they smoke more!
These territorial differences are not random. They reflect social and economic inequalities. Tobacco use is more common in the most disadvantaged communities and is closely linked to income level, education level, and employment status.
Tobacco is therefore not only a medical issue but also a marker of social health inequalities. According to data regularly published by Santé publique France and the French Observatory of Drugs and Addiction Trends (OFDT), disparities in consumption between social categories persist, despite pricing policies.
Cancer in the Forefront, But Not Only
When people think of tobacco, they often immediately think of lung cancer—and with good reason. According to the 2023 report:
- 57% of deaths attributable to tobacco are linked to cancer.
Tobacco is involved in many cancers: lung, throat, mouth, esophagus, bladder, pancreas… It contains more than 7,000 chemicals, dozens of which are proven carcinogens.
But tobacco doesn’t stop at cancer. The report also specifies that:
- One-third of deaths from chronic respiratory diseases are attributable to tobacco.
- Approximately one in ten deaths from cardiovascular and neurological diseases is linked to smoking.
In other words, tobacco weakens the lungs, but also the heart and blood vessels. It promotes atherosclerosis (plaque buildup in the arteries), increases the risk of heart attack and stroke, and accelerates the aging of the cardiovascular system.
Smoking: Why Do the French Continue to Smoke So Much?
Old Anti-Tobacco Policies… But Health Inertia
Since the 1990s, France has multiplied measures to combat tobacco:
- advertising ban (Evin Law)
- smoking bans in public places
- regular increases in pack prices
- plain packaging
- national prevention campaigns
- partial reimbursement of nicotine substitutes
The price of a pack of cigarettes now approaches €13. Health warnings cover most of the package surface. So why these 68,000 deaths? The answer lies in part in a phenomenon called epidemiological inertia.
Diseases related to tobacco often take decades to appear. The deaths observed today reflect behaviors of the past. Generations who smoked heavily in the 1980s and 1990s are now reaching the ages when cancers and cardiovascular diseases develop.
A Fragile Decline in Smoking
In recent years, France has seen a decrease in the number of daily smokers, particularly after the sharp price increases between 2017 and 2020. However, this decline appears to be slowing.
The dynamic remains fragile, especially among young adults and in certain social groups. Among younger generations, cigarette use is declining, but vaping is increasing. Surveys by Santé publique France and the OFDT show an increase in e-cigarette use among adolescents and young adults, sometimes in addition to tobacco.
the positive health effects of a recent decline will only be visible in several decades. In other words, even if fewer people start smoking today, the consequences of past decades will continue to appear in mortality statistics.
A Tobacco-Free Generation: An Achievable Goal?
Public authorities have set an ambitious goal: to create a “tobacco-free generation” by 2032. The ambition is clear: to ensure that less than 5% of 18-year-olds are smokers.
The challenge is twofold:
- Preventing initiation into tobacco use.
- Supporting current smokers to quit.
Studies show that the earlier someone quits, the faster the benefits. Quitting smoking before age 40 prevents the majority of the increased risk of mortality associated with tobacco.
But quitting remains difficult. Nicotine creates a strong addiction, both physical and psychological. Tobacco is also embedded in social habits, daily routines, and stressful moments. Despite anti-tobacco policies, despite warnings on packs, despite repeated campaigns… Quitting smoking remains a major challenge for consumers.
GOOD TO Realize
According to Santé publique France, secondhand smoke causes approximately 3,000 deaths each year in France. These are people regularly exposed to the smoke of others, at home or in the workplace. Secondhand smoke also contains carcinogenic and toxic substances. It increases the risk of lung cancer, cardiovascular disease, and can worsen asthma or respiratory infections in children.
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