Quantifying the macroeconomic burden of tobacco-attributable cancers in 2023: Global disparities in value-of-lost-welfare (VLW) in 189 countries.

10567 Background: Tobacco use is the leading preventable cause of cancer globally, yet the macroeconomic welfare losses attributable to tobacco-related cancers remain incompletely quantified. We estimated the global economic burden of tobacco-attributable cancers in 2023 using a standardized value-of-lost-welfare (VLW) framework. Methods: Country-level disability-adjusted life years (DALYs) attributable to tobacco for all cancers were obtained from the Global Burden of Disease (GBD) 2023 framework. Gross domestic product (GDP; purchasing power parity, current international dollars) and population data were sourced from the World Bank. VLW was calculated as tobacco-attributable cancer DALYs multiplied by country-specific GDP per capita (PPP). Outcomes included total VLW, per-capita VLW, and VLW as a percentage of national GDP. Results: In 2023, tobacco-attributable cancers resulted in 48.44 million DALYs globally (95% UI: 41.06–57.06 million), corresponding to a global value of lost welfare (VLW) of USD 1.61 trillion. The largest absolute economic welfare losses were observed in China (USD 415.3 billion), India (USD 262.8 billion), and the United States (USD 219.4 billion), followed by Japan (USD 96.1 billion) and Brazil (USD 63.7 billion). Together, these five countries accounted for 65.9% of the global VLW attributable to tobacco-related cancers. When normalized to national economic output, the highest VLW-to-GDP ratios were observed in India (1.12%), China (0.69%), Egypt (0.61%), Bangladesh (0.58%), and Pakistan (0.52%), indicating substantial macroeconomic vulnerability in several low- and middle-income countries. By cancer type, tracheal, bronchus, and lung cancer accounted for 24.6 million DALYs, corresponding to a VLW of USD 0.82 trillion, followed by esophageal cancer (6.1 million DALYs; USD 0.21 trillion), stomach cancer (5.4 million DALYs; USD 0.18 trillion), liver cancer (4.9 million DALYs; USD 0.16 trillion), and oral cavity cancer (3.2 million DALYs; USD 0.11 trillion). Collectively, these five cancer types accounted for 91.4% of total tobacco-attributable cancer VLW worldwide. Conclusions: In 2023 alone, tobacco-attributable cancers resulted in nearly 50 million DALYs and over $1.6 trillion in lost economic welfare worldwide, highlighting tobacco use as a dominant driver of both health loss and macroeconomic harm. Regional distribution of disability-adjusted life years (DALYs) and economic welfare loss (VLW) attributable to tobacco-related cancers in 2023. Region DALYs (millions) VLW (USD trillion) VLW/GDP (%) High-income 11.6 0.75 1.81 Central Europe, Eastern Europe, and Central Asia 4.58 0.17 1.27 Southeast Asia, East Asia, and Oceania 22.87 0.53 1.14 North Africa and Middle East 2.27 0.05 0.57 Latin America and Caribbean 1.72 0.03 0.29 South Asia 4.33 0.04 0.22 Sub-Saharan Africa 0.98 0.00 0.12