Health Burden of Tobacco Use
in Kenya
In Kenya, about 12,000 individuals die from tobacco smoking each year.
In 2022, forty six percent of 2000 Kenyan patients undergoing treatment for chronic respiratory disease, cardiovascular disease, diabetes mellitus, malignant cancers and tuberculosis, had a history of tobacco use.
For every $1 earned from the tobacco industry, the Kenyan economy loses $2.2 – 3.
In 2014, 11% of the Kenyan population aged 15 years and above (2.5 million people) used tobacco products (GATS, 2014). Tobacco smoking is a risk factor for numerous diseases, including chronic respiratory diseases, cardiovascular diseases, various cancers, and diabetes. Tobacco use results in disability and death and imposes significant economic costs on Kenya’s health system and economy.
This page presents data collected and analyzed in 2022 by the Tobacco Control Data Initiative (TCDI) on the morbidity (state of being symptomatic for a disease)
and mortality (number of deaths caused by a health event) from tobacco use in Kenya and the economic cost thereof. The data on morbidity and economic costs was collected from 2,032 patients aged 18 years and above at 4 major national referral hospitals in Kenya all suffering from 10 tobacco-related illnesses. While data on mortality was collected from the Civil Registration and Vital Statistics Unit within the Kenyan Ministry of Health. The data set, code book and questionnaire are available for download on the Data and Methods page. Download the research report here.
Morbidity Caused by
Tobacco Use
In Kenya, NCDs account for more than 50% of in-patient hospital admissions and 39% of all deaths annually. Tobacco use is a risk factor for NCDs that contributes to these hospital admissions.
Distribution of Tobacco Related Illnesses Among Patients Surveyed in Four Major Hospitals in Kenya, 2022
Source: TCDI Kenya Morbidity Study, 2022
In 2015, tobacco-related diseases were the second leading cause of diseases worldwide.
The evidence linking smoking to diabetes, rheumatoid arthritis, colorectal cancer, and ectopic pregnancy is overwhelming. Exposure to Second Smoke has also been linked to stroke Tobacco smoking is associated with 24% and 44% of disability-adjusted life years (DALYs) attributable to ischaemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD, respectively.In the TCDI study, the most common tobacco related illness was oral-pharyngeal cancer. About one in three patients who sought treatment for a TRI suffered from oral-pharyngeal cancer and one in ten patients suffered from lung cancer. Peripheral arterial disease had the lowest prevalence at 2% followed by esophagus cancer and myocardial infarction at (3%) each.
Prevalence of Tobacco Use Among Patients with TRIs in Kenya
Article 5 of the FCTC mandates a comprehensive multi-sectoral approach to the implementation of tobacco control measures. This requires high level political commitment and a whole of government approach.
46% of patients who had been diagnosed with a tobacco-related illness (TRI) within the past five years had a history of tobacco use.
Prevalence of Tobacco Use Among Patients with Tobacco-Related Illnesses, 2022
Source: TCDI Kenya Morbidity Study, 2022
The TCDI study sought to ascertain the previous and present use of tobacco products among patients hospitalized with TRI diagnoses. Six percent of the study participants were current tobacco users, while 40% were former users. With regard to smokeless tobacco use, 1% were current users while 6% were former users. The average number of cigarettes smoked per patient was 7.7 sticks. Majority of current tobacco users (88%) were men. Comorbidities were present in 28% of the study participants, with men having more comorbidities than women (54%). Overall, 60% of the current tobacco users had tried to quit smoking in the past 12 months.
The proportion of tobacco users varied across the different diseases, with the highest proportion found among patients with laryngeal cancer (61%) and chronic bronchitis (60%) (The diseases with the lowest proportion of tobacco users were cerebral vascular accidents (23%) and myocardial infarctions (33%) Furthermore, the study found that smokeless tobacco was a significant factor in the development of a number of TRIs, including chronic bronchitis, emphysema, TB, and oropharyngeal cancer.
Factors Associated with Tobacco Use Among Patients With TRIs
More men than women in Kenya suffer from tobacco-related illnesses (TRIs). The degree of tobacco use depended on gender, age, marital status and alcohol consumption. According to the TCDI study, single men who consumed alcohol also had higher chances of getting a TRI. Further, people that had been diagnosed with TRI for over 10 years were 53% less likely to use tobacco than people diagnosed with TRI within five years.
Factors Associated with Tobacco Use
Source: TCDI Kenya Morbidity Study, 2022
Gender Differences in Morbidity From Tobacco Use
Tobacco-Related Illnesses Disaggregated by Gender, 2022
Source: TCDI Kenya Morbidity Study, 2022
In the TCDI study, more men than women had TRIs. However, incidence of CVD was higher in women (55%) than men (45%).
Mortality Caused by
Tobacco Use
Between 2012 and 2021, 60,118 people aged 35 years and above in Kenya died from illnesses associated with tobacco use. Of these fatalities, 9,943 (16.5%) were attributable to cigarette smoking.
In Kenya, close to one in five deaths from Tobacco-related illnesses (TRIs) are attributable to cigarette smoking. This is higher than what has been found in countries such as Germany (17.4% for male and 9.11% for females)
and Spain at 11%.Cigarette Smoking Attributable Mortality in Kenya For Persons aged 35+ (2012-2021) by Disease
Source: TCDI Kenya Mortality Study, 2022
In 2015, tobacco smoking caused 69 deaths per 100,000 in those aged 30 years and older in Kenya. Tobacco smoking was responsible for 5% of all noncommunicable disease (NCD) fatalities in Kenya.
Cardiovascular diseases (CVDs) were the leading cause of death from tobacco use followed by cancers, respiratory diseases, and diabetes. These 4 diseases accounted for 82% of all tobacco related noncommunicable disease (NCD) deaths.However, the TCDI study indicates that as of 2022, chronic respiratory diseases at 41% had overtaken CVDs at 9% as the main cause of tobacco related deaths. This may be attributed to COVID-19 which directly and indirectly increased respiratory disease mortality outcomes.
The analysis of deaths in Kenya between 2012-2021 indicated that there was a double increase in pneumonia and influenza cases in 2020 due to COVID-19, from an average of 1,668 deaths in the previous nine years to 3,700 deaths in 2020.Malignant cancers, tuberculosis and diabetes accounted for 31%, 13% and 6% of the tobacco-related deaths respectively.
Cigarette Smoking Attributable Mortality in Kenya For Persons aged 35+ (2012-2021) by Gender
Source: TCDI Kenya Mortality Study, 2022
Out of the 9,934 deaths attributable to tobacco smoking, 8.7% were women and 91.3% were men, chiefly because men smoke more than women. The leading causes of tobacco related deaths for women between 2012 – 2021 were respiratory diseases and cancers. In the same period, tobacco use caused 87% of the trachea, lung, and bronchi cancer related deaths in men and 28.7% of the bronchitis/emphysema cases in women.
Cancer Deaths from Tobacco Use
The most prevalent cancers attributable to cigarette smoking are cancers of the respiratory system.
Cancer Related Deaths for Persons Aged 35+ Attributed to Cigarette Smoking (2012-2021)
Source: TCDI Kenya Mortality Study, 2022
According to the TCDI study, between 2012-2021 about one in three deaths of the cancers studied were attributable to smoking. 70.5% of the larynx cancer deaths were attributed to smoking followed by cancers of lung/trachea cancer (59.6%), lip/oral cavity/pharynx cancer (50.5%), and esophagus (47.6%) cancer. These findings are consistent with other studies which show that lung and esophageal cancers account for a significant percentage of mortality caused by smoking.
Global studies show that cigarette smoking is linked to 80%-90% of lung cancer deaths. and accounts for 60% of deaths from lung, bronchial, and tracheal cancers.Respiratory Diseases and Tobacco Use
Between 2012 and 2021, the highest number of deaths linked to tobacco smoking were from respiratory diseases (40.5%), with men having significantly higher death rates than women.
Respiratory Disease Related Deaths Attributable to Tobacco Smoking for Persons Aged 35+ (2012-2021)
Source: TCDI Kenya Mortality Study, 2022
In the TCDI study, 4,030 people (3,617 men and 413 women) died of respiratory related diseases directly caused by smoking between 2012-2021. Pneumonia and influenza (58.5% ) were the leading cause of respiratory deaths followed by COPD (39%) and bronchitis/emphysema (2.5%). There was a double increase in pneumonia and influenza cases in 2020 due to COVID-19, rising from an average of 1,668 deaths in the previous nine years to 3,700 deaths in 2020.
This differs from the 2019 Global Burden of Disease (GBD) study,
which reported that COPD was the most significant burden of death for chronic respiratory disease. . This disparity may be linked to the sub-optimal diagnosis or under-reporting of COPD in Kenya. Based on the 2019 GBD study, tobacco smoking was the leading risk factor for death among individuals with CRDs worldwide. However, the extent differed, with middle, middle-high, and high-income countries having the higher risk.
Economic Costs From
Tobacco Use
The Direct (treatment) and indirect (productivity) costs of tobacco smoking outweigh the financial benefits from tobacco.
In 2021, Kenya spent between $544.4 and $756.2 million to treat TRIs. Of this amount, between 27% and 48% were indirect costs while between 52% to 73% were health care related costs. These tobacco-related healthcare costs burden the country’s health systems that are already struggling to deal with numerous communicable diseases, limited numbers of medical personnel, and poor infrastructure. They also place considerable strain on individuals and families, given that health insurance coverage only stands at 26%.
Australia
In 2016, for every AUD1 gained from excise tobacco revenue AUD12 was lost to tobacco related economic cost.
South Africa
In 2016, for every every US$1 gained from tobacco tax revenue, US$3.4 was lost to direct & indirect tobacco costs.
Uganda
In 2017, for every US$1 invested in the tobacco industry, the tobacco related economic cost was $3.
Kenya
In 2022, for every dollar accrued from tobacco revenue and tax, the country lost between USD 2.2 and USD 3 to costs associated with Tobacco-Related Illnesses.
Healthcare Costs (USD) by Disease Per Patient
Cost of Treating Tobacco Related Illnesses, 2022
Source: TCDI Kenya Economic Cost of Tobacco Related Illness Study, 2022
The TCDI study investigated how much it costs to treat a patient suffering from each tobacco related illness (TRI). Lung cancer had the highest cost per case, at $23,365, followed by oral-pharyngeal cancer at $7,637. The disease with the least cost per case was tuberculosis, at $1,044.However, tuberculosis costs are fully subsidized by the Kenyan government. Medicine and staff expenditures make up the bulk of these costs.
Healthcare Costs Attributable to Tobacco use by TRI
Total Healthcare Cost Attributable to Tobacco Use by Tobacco-Related Illnesses, 2022
Source: TCDI Kenya Economic Cost of Tobacco Related Illness Study, 2022
The total TRI attributable healthcare costs were $396,107,364 in 2022. The cost of care was highest for Myocardial infarctions (at $158,687,627), followed by peripheral arterial disease ($72,858,528). Oropharyngeal cancers generated the least healthcare costs, at $119,139.
Productivity Losses
The productivity loss (indirect costs) due to the TRIs was between $148.6 and $360.12 million.
Indirect Costs From Tobacco Related Illnesses (Million $), 2021
Source: TCDI Kenya Economic Cost of Tobacco Related Illness Study, 2022
Emphysema had the highest productivity losses, ranging from $54.3 to $63.3 million. Tuberculosis had equally high productivity losses at between $ 39.49 and $53.68 million. Oropharyngeal cancer had the least productivity costs, ranging from $0.02 to $0.04 million.
Total Economic Effect of Tobacco Use
Total Tobacco Attributable TRI’s Loss to the Economy, 2021
Source: TCDI Kenya Economic Cost of Tobacco Related Illness Study, 2022
The total economic losses attributable to tobacco use from the selected TRIs ranged between $544.72 to $756.22 million. Myocardial infarction had the highest total economic losses, between $171.43 to 233.06 million, while oropharyngeal cancer had the lowest ($0.14 – $ 0.16 million). The productivity losses from tobacco use among the selected TRI accounted for between 27%-48% of the total tobacco attributable TRI’s loss to the economy. The cost benefit ratio was between 2.2 to 3, signifying that for every dollar accrued from tobacco revenue and tax we lose between $2.2 and $3 to costs associated with Tobacco related illnesses. The revenues and tax from the tobacco value chain only covered 63.8% of the estimated health expenditures caused by tobacco use.
Recommendations and
Policy Implication
The TCDI study is the first in Kenya that has quantified the morbidity and mortality associated with tobacco use and its economic implications. The findings are useful in informing public health policy, and the following recommendations are proposed:
1. Strengthen the implementation of the Framework Convention on Tobacco Control (FCTC) by enforcing the provisions of the Tobacco Control Act at both the national and county level to reduce the prevalence of tobacco use.
2. Integrate robust cessation programs in health facilities, workplaces, higher education institutions, and community settings. Cessation programs should be within easy reach to the public and integrated within universal health coverage packages.
3. Gender mainstreaming in policies – Tobacco control policies and interventions should be designed with a gender perspective, given the difference in tobacco use prevalence and morbidity outcomes for men and women.
4. Conduct prospective studies with linkage to electronic records that can measure both mortality and morbidity to assess and monitor the tobacco epidemic
5. Monitor tobacco use-attributable morbidity, mortality and economic implications of other tobacco related illnesses not covered in this study.
6. Integrate tobacco use indicators in national health surveys to supplement the data collected in periodic NCD and tobacco control surveys for proper planning.
7. Accountability of tobacco funds – Make prudent use of the funds collected through the solatium compensatory contribution paid by the tobacco industry under S 7 of the Tobacco Control Act. Funds should be used to provide cessation programs and meet health care costs related to managing TRI.
8. Progressively increase tobacco taxes in Kenya to reduce tobacco consumption and healthcare costs associated with tobacco consumption.
