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

BMC Public Health

Research Article

Anna B. Gilmore¹  Chris Kypridemos²  Simon Capewell²  Martin O’Flaherty²  Margaret Whitehead²  Lirije Hyseni²  Peter Diggle³  Kirk Allen⁴ 

[1] Department for Health, University of Bath, UK Centre for Tobacco and Alcohol Studies (UKCTAS), Bath, UK;Department of Public Health & Policy, University of Liverpool, Liverpool, UK;Lancaster Medical School, Lancaster University, Lancaster, UK;Lancaster Medical School, Lancaster University, Lancaster, UK;Department of Public Health & Policy, University of Liverpool, Liverpool, UK;

关键词: Tobacco control;    Framework Convention on Tobacco Control (FCTC);    Coronary heart disease;    Socioeconomic inequalities;   

DOI  :  10.1186/s12889-016-2962-8

 received in 2015-08-30, accepted in 2016-03-15,  发布年份 2016

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Allen et al. 2016