Article Text

Download PDFPDF
Estimating the long-run relationship between state cigarette taxes and county life expectancy
  1. Aaron Baum1,
  2. Sandra Aguilar-Gomez2,
  3. James Lightwood3,
  4. Emilie Bruzelius1,4,
  5. Stanton A Glantz5,
  6. Sanjay Basu6
  1. 1 Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA
  2. 2 School of International and Public Affairs, Columbia University, New York, USA
  3. 3 Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, California, USA
  4. 4 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
  5. 5 Department of Medicine, University of California, San Francisco, California, USA
  6. 6 Department of Medicine, Stanford University, Palo Alto, California, USA
  1. Correspondence to Dr Aaron Baum, Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York NY 10029, USA; aaron.baum{at}


Introduction 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.

Methods 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.

Results 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.

Conclusions Results suggest that increasing cigarette excise tax rates translates to consequential population-level improvements in life expectancy, with larger effects in low-income counties.

  • taxation
  • public policy
  • smoking caused disease

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Study conception and design: AB, SB; acquisition of data: AB, SAG, SB; analysis and interpretation of data: AB, SAG, JL, EB, SAGl, SB; drafting of manuscript: AB, SAG, JL, SB; critical revision: AB, SAG, JL, EB, SAGl, SB. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding This research was supported by the US Social Security Administration through grant RRC08098400-09 to the National Bureau of Economic Research as part of the SSA Retirement Research Consortium and by the National Institutes of Health (National Institute on Drug Abuse R01DA043950 and National Institute on Minority Health and Health Disparities DP2MD010478).

  • Disclaimer The findings and conclusions expressed are solely those of the author(s) and do not represent the views of SSA, the National Institutes of Health, any agency of the Federal Government or the NBER.

  • Competing interests None declared.

  • Ethics approval The analysis was deemed exempt from review by the Icahn School of Medicine Institutional Review Board, Protocol ID# 17-02303.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Life expectancy, cigarette smoking prevalence and cigarette tax rate data are publicly available and can be downloaded at, and, respectively.

  • Patient consent for publication Not required.