Modeling predicted that tobacco control policies targeted at lower educated will reduce the differences in life expectancy

Estimating the Population Health Impact of Recently Introduced Modified Risk Tobacco Products: A Comparison of Different Approaches

INTRODUCTION

Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP).

AIMS AND METHODS

We aimed to compare and contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018.

RESULTS

Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the "null scenario" or joint smoking and MRTP habits in an "alternative scenario". The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized.

CONCLUSIONS

Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction.

IMPLICATIONS

There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates.

Mathematical Modeling in Tobacco Control Research: Initial Results From a Systematic Review

OBJECTIVES

The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models.

METHODS

We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies.

RESULTS

The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies.

CONCLUSIONS

This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work.

What is the association of smoking and alcohol use with the increase in social inequality in mortality in Denmark? A nationwide register-based study

OBJECTIVES

The aim of this paper is to estimate the impact of smoking and alcohol use on the increase in social inequality in mortality in Denmark in the period 1985-2009.

DESIGN

A nationwide register-based study.

SETTING

Denmark.

PARTICIPANTS

The whole Danish population aged 30 years or more in the period 1985-2009.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome is mortality rates in relation to educational attainments calculated with and without deaths related to smoking and alcohol use. An absolute measure of inequality in mortality is applied along with a result on the direct contribution from smoking and alcohol use on the absolute difference in mortality rates. The secondary outcome is life expectancy in relation to educational attainments.

RESULTS

Since 1985, Danish overall mortality rates have decreased. Alongside the improvement in mortality, the absolute difference in the mortality rate (per 100,000 persons) between the lowest and the highest educated quartile grew from 465 to 611 among men and from 250 to 386 among women. Smoking and alcohol use have caused 75% of the increase among men and 97% of the increase among women. Among men the increase was mainly caused by alcohol. In women the increase was mainly caused by smoking.

CONCLUSIONS

The main explanation for the increase in social inequality in mortality since the mid-1980s is smoking and alcohol use. A significant reduction in the social inequality in mortality can only happen if the prevention of smoking and alcohol use are targeted to the lower educated part of the Danish population.

Describing socioeconomic inequalities in health in European countries: an overview of recent studies

Many studies have documented, for all European populations for which data are available, that people from lower socioeconomic groups have shorter lives and more often suffer from health problems. The reduction of socioeconomic inequalities in health is an important challenge for health policies. Descriptive research is important to inform these policies, together with explanatory and interventions research. The specific challenges of descriptive research are (a) to document health inequalities for populations, places, and periods not yet covered by previous studies, (b) to move from generic health measures to disease-specific health outcomes, (c) to document inequalities in specific risk factors such as smoking, and (d) to apply improved measures of socioeconomic position. For each area, this paper gives a brief overview of recent progress made in descriptive studies at European level. The illustrations in this paper showed how existing data sources could be used to describe socioeconomic inequalities in health, and how new insights can be obtained by applying innovative methods. Further descriptive work should aim to identify priority areas for explanatory and intervention studies.