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.
- public policy
- smoking caused disease
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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 http://ghdx.healthdata.org/record/united-states-life-expectancy-and-age-specific-mortality-risk-county-1980-2014, http://ghdx.healthdata.org/record/united-states-smoking-prevalence-county-1996-2012 and https://chronicdata.cdc.gov/Legislation/CDC-STATE-System-Tobacco-Legislation-Smokefree-Ind/2snk-eav4, respectively.
Patient consent for publication Not required.