Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA.
School of International and Public Affairs, Columbia University, New York, USA.
Tob Control. 2020 Jan;29(1):81-88. doi: 10.1136/tobaccocontrol-2018-054686. Epub 2019 Jan 31.
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.
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.
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.
Results suggest that increasing cigarette excise tax rates translates to consequential population-level improvements in life expectancy, with larger effects in low-income counties.
大量文献表明，烟草控制立法（包括消费税等财政措施）可有效减少吸烟行为，但尚未直接评估香烟消费税与预期寿命之间的长期（10 年以上）关系。在此，我们检验了这样一个假设，即州香烟消费税的增加与人群预期寿命的长期增长呈正相关。
我们通过性别研究了 1996 年至 2012 年间美国所有县的标准化年龄预期寿命，与每年的州香烟消费税税率有关，同时控制了其他人口统计学、社会经济和县级特定特征。我们使用误差修正模型来评估税收与预期寿命之间的长期关系。我们还检验了香烟税与预期寿命之间的关系是否通过县吸烟率的变化来介导，以及这种关系是否因县的性别、收入和城乡构成而异。
每包香烟消费税增加 1 美元（以 2016 年美元计算），长期内县预期寿命将增加 1 年（95%CI：0.60 至 1.40 年），而预期寿命的首次 6 个月增加需要 10 年才能实现。这种关联通过吸烟率的变化来介导，而且随着县收入的降低，关联的幅度稳步增加。
结果表明，提高香烟消费税税率可带来人群预期寿命的实质性改善，低收入县的效果更大。
