A workforce up in smoke? Examining trends in health-related economic inactivity by smoking status in England, 2013-2025

ObjectivesTo examine time trends in health-related economic inactivity among working-age adults in England by smoking status between 2013 and 2025, and to estimate the number of smokers economically inactive due to ill health in 2025. DesignRepeat cross-sectional analysis of data from a nationally representative survey (the Smoking Toolkit Study). SettingEngland. Participants173,248 adults aged 18-64y surveyed between March 2013 and February 2025. Main outcome measuresHealth-related economic inactivity was defined as not being in paid work due to long-term illness or disability. Logistic regression modelled time trends adjusted for age and gender, by (i) smoking status (current, former, never) and (ii) duration of abstinence among former smokers. National population and smoking prevalence data were used to estimate absolute numbers of inactive smokers. ResultsAcross the period, health-related economic inactivity more than doubled in all adults (2.5% [2.3-2.7%] to 5.5% [5.1-5.9%]; prevalence ratio PR=2.21 [1.96-2.49]). Prevalence was consistently highest - and absolute increases over time were largest - among current smokers; reaching 11.3% [9.9-12.7%] in 2025, compared with 5.8% [5.0-6.6%] in former smokers and 3.3% [2.9-3.7%] in never smokers. This equates to [~]750,000 current smokers not in work due to ill health or disability in 2025, up from [~]390,000 in 2013. Among former smokers, inactivity was highest in recent quitters and declined with longer abstinence duration. ConclusionsCurrent smoking is strongly associated with health-related economic inactivity, and this disparity has widened in absolute terms over time. In early 2025, one in nine working-age adults in England who smoked was not in work due to long-term illness or disability. Efforts to reduce smoking prevalence may contribute to tackling rising inactivity and improving labour market participation.