Szklo André Salem, Yuan Zhe, Levy David
Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil.
Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, U.S.A.
Cad Saude Publica. 2017 Dec 18;33(12):e00207416. doi: 10.1590/0102-311X00207416.
A previous application of the Brazil SimSmoke tobacco control policy simulation model was used to show the effect of policies implemented between 1989 and 2010 on smoking-attributable deaths (SADs). In this study, we updated and further validated the Brazil SimSmoke model to incorporate policies implemented since 2011 (e.g., a new tax structure with the purpose of increasing revenues/real prices). In addition, we extended the model to estimate smoking-attributable maternal and child health outcomes (MCHOs), such as placenta praevia, placental abruption, preterm birth, low birth weight, and sudden infant death syndrome, to show the role of tobacco control in achieving the Millennium Development Goals. Using data on population, births, smoking, policies, and prevalence of MCHOs, the model is used to assess the effect on both premature deaths and MCHOs of tobacco control policies implemented in Brazil in the last 25 years relative to a counterfactual of policies kept at 1989 levels. Smoking prevalence in Brazil has fallen by an additional 17% for males (16%-19%) and 19% for females (14%-24%) between 2011 and 2015. As a result of the policies implemented since 1989, 7.5 million (6.4-8.5) deaths among adults aged 18 years or older are projected to be averted by 2050. Current policies are also estimated to reduce a cumulative total of 0.9 million (0.4-2.4) adverse MCHOs by 2050. Our findings show the benefits of tobacco control in reducing both SADs and smoking-attributable MCHOs at population level. These benefits may be used to better inform policy makers in low and middle income countries about allocating resources towards tobacco control policies in this important area.
巴西SimSmoke烟草控制政策模拟模型先前的应用被用来展示1989年至2010年实施的政策对吸烟所致死亡（SADs）的影响。在本研究中，我们更新并进一步验证了巴西SimSmoke模型，以纳入自2011年以来实施的政策（例如，旨在增加收入/实际价格的新税收结构）。此外，我们扩展了该模型以估计吸烟所致的母婴健康结局（MCHOs），如前置胎盘、胎盘早剥、早产、低出生体重和婴儿猝死综合征，以展示烟草控制在实现千年发展目标中的作用。利用关于人口、出生、吸烟、政策以及MCHOs患病率的数据，该模型被用于评估相对于保持在1989年水平的反事实政策，过去25年巴西实施的烟草控制政策对过早死亡和MCHOs的影响。2011年至2015年间，巴西男性吸烟率又下降了17%（16%-19%），女性下降了19%（14%-24%）。由于自1989年以来实施的政策，预计到2050年可避免18岁及以上成年人中的750万（640万-850万）例死亡。据估计，现行政策到2050年还将累计减少90万（40万-240万）例不良MCHOs。我们的研究结果显示了烟草控制在人群层面减少SADs和吸烟所致MCHOs方面的益处。这些益处可用于更好地告知低收入和中等收入国家的政策制定者在这一重要领域将资源分配到烟草控制政策上。
