One-third of those killed are children, often exposed to smoke at home, the World Health Organization (WHO) found.
The study, in 192 countries, found that passive smoking is particularly dangerous for children, said to be at higher risk of sudden infant death syndrome, pneumonia and asthma.
Passive smoking causes heart disease, respiratory illness and lung cancer.
"This helps us understand the real toll of tobacco," said Armando Peruga, of the WHO's Tobacco-Free Initiative, who led the study.
'Deadly combination'
The study used estimates of the incidence of specific diseases and of the number of people exposed to second-hand smoke in particular areas.
The global health body said it was particularly concerned about the estimated 165,000 children who die of smoke-related respiratory infections, mostly in South East Asia and in Africa.
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