Estimated public health gains from smokers in Germany switching to risk-reduced alternatives: Results from population health impact modelling by socioeconomic group

Abstract Background Previously, we estimated the impact of introducing heat-not-burn products and e-cigarettes in Germany between 1995 and 2015 on mortality from the four main smoking-related diseases in men and women aged 30–79 years. Deaths would have reduced by 216,650 (from 852,357 for continued smoking) had everyone quit smoking in 1995 and by 39,818 − 179,470 had one or both of heat-not burn products and e-cigarettes been introduced and adopted to varying extents. Here, we report substantial mortality reductions separately in two socioeconomic groups (A = higher, B = lower) defined by income and education. Methods Modelling is essentially as before, with individuals of a given sex, age range and cigarette smoking distribution followed over time under a “Null Scenario” (reduced-risk products never introduced) and various “Alternative Scenarios” (reduced-risk products introduced), the individual product histories generated then allowing estimation of reductions in mortality for each Alternative Scenario compared to the Null Scenario. Here, however, individuals are subdivided into two socioeconomic groups with transition probabilities between product use groups varying by group as well as by sex, age and length of follow-up. The possibility of transitioning between socioeconomic groups is also allowed for. Results Where all cigarette smokers switch immediately, half to each new product, the drops in deaths were estimated as 60,081 in group A and 122,343 in group B, about 82% of the drops associated with immediate cessation (72,725 A, 147,684 B). Where the conversion was more gradual, the drops were about 35% of those from cessation (25,648 A, 52,652 B). Drops were about two times higher in B, because of their greater numbers, older age, and higher frequency of current smokers. Years of life saved were also higher (about 1.5 times) in B than A. Conclusions Methodological limitations would not have affected our conclusion that introducing these products in 1995 in Germany could have substantially reduced mortality in each group, with greater gains in B. While cessation is the best choice to reduce mortality, switching to reduced-risk products also provides substantial health gains. Encouraging lower socioeconomic group smokers who would otherwise continue smoking to fully switch to reduced-risk products could diminish smoking-related health inequalities.