This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Romana Rytsar
Philip Morris International Research and Development Campus Neuchatel
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1936-1300
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Smoking is associated with cancer and cardiorespiratory disease mortality. Reducing smoking prevalence reduces deaths and life-years lost. Here, we estimate the impact of introducing heat-not-burn products and e-cigarettes in Germany from 1995 to 2015 on mortality from lung cancer, chronic obstructive pulmonary disease, ischaemic heart disease, and stroke in men and women aged 30–79 years.
Methods
We used the previously described population health impact model. Modelling starts with individuals of a given sex and age range with a defined cigarette smoking distribution. They are then followed under a “Null Scenario”, where reduced-risk products are never introduced, and one of seven “Alternative Scenarios”, where they are. Transition probabilities allow tobacco product use to change annually, and the individual product histories then allow estimation of risks, relative to never users, for each year and Scenario, which are then used to estimate reductions in deaths and life-years lost for each Alternative Scenario.
Results
In the Null Scenario, we estimated 852,357 deaths from cigarette smoking, with 8.61 million life-years lost. Had everyone quit in 1995, with no further use of the three products, these numbers would reduce by 216,650 and 2.88 million. The reductions would be 159,278 and 2.06 million with an immediate complete switch from cigarettes to heat-not-burn products, and 179,470 and 2.34 million with an immediate switch to 50% heat-not-burn products and 50% e-cigarettes. In four Scenarios with a more gradual switch, estimated decreases were 39,818–81,293 deaths and 0.50–1.05 million life-years, representing 17.5%-37.5% of the effect of cessation. These estimates assume switching to heat-not-burn products and e-cigarettes involves risk decreases of 80% and 95% of those from quitting. The decreases would have increased, had more diseases and a wider age range been considered, and also with a longer follow-up period, the decreases increasing markedly with time.
Conclusions
Various limitations are discussed, none affecting our conclusion that introducing these new products into Germany in 1995 could have substantially reduced mortality. Our results imply deaths from cigarette smoking could be substantially reduced, both by cessation and switching to reduced-risk products. Risk-proportionate public health campaigns and regulation might increase such switching.
Keywords
Smoking, public health, modelling, lung cancer, chronic obstructive pulmonary disease, ischaemic heart disease, stroke, e-cigarettes, heat-not-burn product, Germany
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
- Paper1AdditionalFile1.docx
Derivation of estimates of cigarette smoking habits in Germany.
- Paper1AdditionalFile2.docx
Derivation of TPs for the Null Scenario.
- Paper1AdditionalFile3.docx
TPs for each Alternative Scenario.
- Paper1AdditionalFile4.docx
Data on population and number of deaths by sex, age, and year.
- Paper1AdditionalFile5.docx
Full output for each Scenario relating to the estimated DDs and YLS, preceded by a description of the contents of the output.
- Paper1AdditionalFile6.docx
Current product use distributions in 2005 for all Scenarios and the overall prevalence of current product users in 2010.
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Romana Rytsar
Philip Morris International Research and Development Campus Neuchatel
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1936-1300
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 28 Dec, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Smoking is associated with cancer and cardiorespiratory disease mortality. Reducing smoking prevalence reduces deaths and life-years lost. Here, we estimate the impact of introducing heat-not-burn products and e-cigarettes in Germany from 1995 to 2015 on mortality from lung cancer, chronic obstructive pulmonary disease, ischaemic heart disease, and stroke in men and women aged 30–79 years.
Methods
We used the previously described population health impact model. Modelling starts with individuals of a given sex and age range with a defined cigarette smoking distribution. They are then followed under a “Null Scenario”, where reduced-risk products are never introduced, and one of seven “Alternative Scenarios”, where they are. Transition probabilities allow tobacco product use to change annually, and the individual product histories then allow estimation of risks, relative to never users, for each year and Scenario, which are then used to estimate reductions in deaths and life-years lost for each Alternative Scenario.
Results
In the Null Scenario, we estimated 852,357 deaths from cigarette smoking, with 8.61 million life-years lost. Had everyone quit in 1995, with no further use of the three products, these numbers would reduce by 216,650 and 2.88 million. The reductions would be 159,278 and 2.06 million with an immediate complete switch from cigarettes to heat-not-burn products, and 179,470 and 2.34 million with an immediate switch to 50% heat-not-burn products and 50% e-cigarettes. In four Scenarios with a more gradual switch, estimated decreases were 39,818–81,293 deaths and 0.50–1.05 million life-years, representing 17.5%-37.5% of the effect of cessation. These estimates assume switching to heat-not-burn products and e-cigarettes involves risk decreases of 80% and 95% of those from quitting. The decreases would have increased, had more diseases and a wider age range been considered, and also with a longer follow-up period, the decreases increasing markedly with time.
Conclusions
Various limitations are discussed, none affecting our conclusion that introducing these new products into Germany in 1995 could have substantially reduced mortality. Our results imply deaths from cigarette smoking could be substantially reduced, both by cessation and switching to reduced-risk products. Risk-proportionate public health campaigns and regulation might increase such switching.
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
- Paper1AdditionalFile1.docx
Derivation of estimates of cigarette smoking habits in Germany.
- Paper1AdditionalFile2.docx
Derivation of TPs for the Null Scenario.
- Paper1AdditionalFile3.docx
TPs for each Alternative Scenario.
- Paper1AdditionalFile4.docx
Data on population and number of deaths by sex, age, and year.
- Paper1AdditionalFile5.docx
Full output for each Scenario relating to the estimated DDs and YLS, preceded by a description of the contents of the output.
- Paper1AdditionalFile6.docx
Current product use distributions in 2005 for all Scenarios and the overall prevalence of current product users in 2010.
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