P.N.Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK.
RoeLee Statistics Ltd., 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK.
BMC Public Health. 2022 May 21;22(1):1025. doi: 10.1186/s12889-022-13441-0.
For smokers not intending to quit, switching to a reduced-risk nicotine product should be healthier than continuing smoking. We estimate the health impact, over the period 2000-2050, had the nicotine pouch ZYN hypothetically been introduced into the US in 2000. ZYN's toxicant profile and method of use is like that for Swedish snus, a product with known health effects much less than smoking.
Our modelling approach is similar to others developed for estimating potential effects of new tobacco products. It starts with a simulated cohort of 100,000 individuals in the year 2000 subdivided by age, sex, and smoking status (including years since quitting). They are followed annually accounting for births, net immigrations, deaths and product use changes, with follow-up carried out in the Base Case (ZYN not introduced) and Modified Case (ZYN introduced). Using informed assumptions about initiation, quitting and switching rates, distributions of the population over time are then constructed for each Case, and used to estimate product mortality based on assumptions about the relative risk according to product use.
Whereas in both Base and Modified Cases, the prevalence of any current product use is predicted to decline from about 22% to 10% during follow-up, in the Modified Case about 25% of current users use ZYN by 2050, about a quarter being dual users and the rest ZYN-only users. Over the 50 years, deaths at ages 35-84 from product use among the 100,000 are estimated as 249 less in the Modified than the Base Case, equivalent to about 700,000 less in the whole US. Sensitivity analyses varying individual parameter values confirm the benefits of switching to ZYN, which increase as either the switching rate to ZYN increases or the initiation rate of ZYN relative to smoking increases. Even assuming the reduction in excess mortality risk using ZYN use is 20% of that from smoking rather than the 3.5% assumed in the main analyses, the reduction in product-related deaths would still be 213, or about 600,000 in the US.
Although such model-based estimates involve uncertainties, the results suggest that introducing ZYN could substantially reduce product-related deaths.
对于不打算戒烟的吸烟者来说，改用低风险尼古丁产品应该比继续吸烟更健康。我们估计，如果假设尼古丁袋 ZYN 于 2000 年引入美国，其对 2000 年至 2050 年期间的健康影响。ZYN 的有毒物质概况和使用方法与瑞典鼻烟类似，后者是一种对健康影响远小于吸烟的产品。
我们的建模方法类似于其他用于估计新型烟草产品潜在影响的方法。它从 2000 年的 100,000 名模拟队列开始，按年龄、性别和吸烟状况（包括戒烟年限）细分。他们每年都会进行跟踪，记录出生、净移民、死亡和产品使用变化，在基础案例（未引入 ZYN）和修改案例（引入 ZYN）中进行跟踪。然后，根据开始使用、戒烟和转换率的知情假设，为每个案例构建一段时间内人口的分布情况，并根据产品使用的相对风险假设来估计产品死亡率。
在基础案例和修改案例中，预计在随访期间，任何当前产品的使用率都将从约 22%下降到 10%，而在修改案例中，到 2050 年，约 25%的当前使用者使用 ZYN，其中四分之一是双重使用者，其余是 ZYN 单一使用者。在这 50 年中，估计在 100,000 名年龄在 35-84 岁的人中，由于产品使用而导致的死亡人数在修改案例中比基础案例少 249 人，相当于整个美国减少了约 70 万人。在不同个体参数值的敏感性分析中，都证实了转换为 ZYN 的好处，随着转换为 ZYN 的比率或相对于吸烟的 ZYN 起始率的增加而增加。即使假设使用 ZYN 降低过度死亡风险的幅度是假设分析中从吸烟降低的 3.5%的 20%，那么产品相关死亡人数仍将减少 213 人，或在美国减少约 60 万人。
尽管这种基于模型的估计存在不确定性，但结果表明，引入 ZYN 可能会大大减少与产品相关的死亡人数。
