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Tob Control. 2019 Jan 31. pii: tobaccocontrol-2018-054686. doi: 10.1136/tobaccocontrol-2018-054686. [Epub ahead of print]

Estimating the long-run relationship between state cigarette taxes and county life expectancy.

Author information

1
Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA.
2
School of International and Public Affairs, Columbia University, New York, USA.
3
Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, California, USA.
4
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA.
5
Department of Medicine, University of California, San Francisco, California, USA.
6
Department of Medicine, Stanford University, Palo Alto, California, USA.

Abstract

INTRODUCTION:

While a large body of literature suggests that tobacco control legislation-including fiscal measures such as excise taxes-effectively reduces tobacco smoking, the long-run (10+ years) relationship between cigarettes excise taxes and life expectancy has not been directly evaluated. Here, we test the hypothesis that increases in state cigarette excise taxes are positively associated with long-run increases in population-level life expectancy.

METHODS:

We studied age-standardised life expectancy among all US counties from 1996 to 2012 by sex, in relation to state cigarette excise tax rates by year, controlling for other demographic, socioeconomic and county-specific features. We used an error-correction model to assess the long-run relationship between taxes and life expectancy. We additionally examine whether the relationship between cigarette taxes and life expectancy was mediated by changes to county smoking prevalence and varied by the sex, income and rural/urban composition of a county.

RESULTS:

For every one-dollar increase in cigarette tax per pack (in 2016 dollars), county life expectancy increased by 1 year (95% CI 0.60 to 1.40 years) over the long run, with the first 6-month increase in life expectancy taking 10 years to materialise. The association was mediated by changes in smoking prevalence and the magnitude of the association steadily increased as county income decreased.

CONCLUSIONS:

Results suggest that increasing cigarette excise tax rates translates to consequential population-level improvements in life expectancy, with larger effects in low-income counties.

KEYWORDS:

public policy; smoking caused disease; taxation

PMID:
30705247
PMCID:
PMC6669122
[Available on 2020-07-31]
DOI:
10.1136/tobaccocontrol-2018-054686

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