The effects of maximising the UK's tobacco control score on inequalities in smoking prevalence and premature coronary heart disease mortality: a modelling study.

Kirk Allen,Peter Diggle,Lirije Hyseni,Simon Capewell,Margaret Whitehead,Martin O’Flaherty,Anna B Gilmore,Chris Kypridemos

doi:10.1186/s12889-016-2962-8

Abstract

BackgroundSmoking is more than twice as common among the most disadvantaged socioeconomic groups in England compared to the most affluent and is a major contributor to health-related inequalities. The United Kingdom (UK) has comprehensive smoking policies in place: regular tax increases; public information campaigns; on-pack pictorial health warnings; advertising bans; cessation; and smoke-free areas. This is confirmed from its high Tobacco Control Scale (TCS) score, an expert-developed instrument for assessing the strength of tobacco control policies. However, room remains for improvement in tobacco control policies.Our aim was to evaluate the cumulative effect on smoking prevalence of improving all TCS components in England, stratified by socioeconomic circumstance.MethodsEffect sizes and socioeconomic gradients for all six types of smoking policy in the UK setting were adapted from systematic reviews, or if not available, from primary studies.We used the IMPACT Policy Model to link predicted changes in smoking prevalence to changes in premature coronary heart disease (CHD) mortality for ages 35–74. Health outcomes with a time horizon of 2025 were stratified by quintiles of socioeconomic circumstance.ResultsThe model estimated that improving all smoking policies to achieve a maximum score on the TCS might reduce smoking prevalence in England by 3 % (95 % Confidence Interval (CI): 1–4 %), from 20 to 17 % in absolute terms, or by 15 % in relative terms (95 % CI: 7–21 %). The most deprived quintile would benefit more, with absolute reductions from 31 to 25 %, or a 6 % reduction (95 % CI: 2–7 %).There would be some 3300 (95 % CI: 2200–4700) fewer premature CHD deaths between 2015–2025, a 2 % (95 % CI: 1.4–2.9 %) reduction. The most disadvantaged quintile would benefit more, reducing absolute inequality of CHD mortality by about 4 % (95 % CI: 3–9 %).ConclusionsFurther, feasible improvements in tobacco control policy could substantially improve population health, and reduce health-related inequalities in England.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2962-8) contains supplementary material, which is available to authorized users.

Highlights

Smoking is more than twice as common among the most disadvantaged socioeconomic groups in England compared to the most affluent and is a major contributor to health-related inequalities
The previously validated, deterministic, cell-based IMPACT Policy Model has been used to model the change in adult smoking prevalence, in England, that might result from changes in tobacco control policies, and translated it to coronary heart disease (CHD) deaths using a population attributable risk fraction approach [13, 14]
Improving all smoking policies to maximize the Tobacco Control Scale (TCS) could reduce overall smoking prevalence in England from 20 % to approximately 17 % (95 % Confidence Interval (CI): 16.0–18.7 %). This would represent an absolute decrease of some 3 % and a relative reduction of approximately 15 %

Summary

Introduction

Smoking is more than twice as common among the most disadvantaged socioeconomic groups in England compared to the most affluent and is a major contributor to health-related inequalities. The United Kingdom (UK) has comprehensive smoking policies in place: regular tax increases; public information campaigns; on-pack pictorial health warnings; advertising bans; cessation; and smoke-free areas. This is confirmed from its high Tobacco Control Scale (TCS) score, an expert-developed instrument for assessing the strength of tobacco control policies. Smoking remains common in England, with 19 % of adults aged 16 and over reported as smokers in 2013 [1]. This prevalence changed slightly from 21 % in 2007 [2]. These numbers may underestimate the true burden of smoking, as a recent study has expanded the list of diseases linked to smoking [6]

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