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Estimated Public Health Gains From Smokers in Germany Switching to Reduced-Risk Alternatives: Results From Population Health Impact Modelling by Socioeconomic Group

Romana Rytsar
Romana Rytsar
, 
Smilja Djurdjevic
Smilja Djurdjevic
, 
Alexander K. Nussbaum
Alexander K. Nussbaum
, 
Ashok Kaul
Ashok Kaul
, 
Emanuel Bennewitz
Emanuel Bennewitz
, 
Peter N. Lee
Peter N. Lee
 oraz 
John S. Fry
John S. Fry
   | 05 maj 2022
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Data publikacji: 05 maj 2022
Zakres stron: 52 - 67
Otrzymano: 27 maj 2021
Przyjęty: 01 mar 2022
DOI: https://doi.org/10.2478/cttr-2022-0005
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© 2022 Romana Rytsar et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Figure 1

Comparison of Null Scenario and derived estimates of current smoking prevalence.
Comparison of Null Scenario and derived estimates of current smoking prevalence.

Figure 2

Nicotine usage in the Conversion Scenario.
Nicotine usage in the Conversion Scenario.

Figure 3

DDs in the Conversion Scenario over the whole follow-up period.
DDs in the Conversion Scenario over the whole follow-up period.

Figure 4

YLS by Scenario and SEG over the whole follow-up period.
YLS by Scenario and SEG over the whole follow-up period.

Drop in deaths by SEG over the follow-up period in Germany in the Alternative Scenarios.

SEG Sc Sex/Scenario DD (n) DD (%)
LC IHD Stroke COPD All four diseases LC IHD Stroke COPD All four diseases
Men
A 1 Complete cessation 15,711 30,736 5,313 4,303 56,062 14.85 53.81 49.02 18.65 28.48
3 Complete switch to RRPs (50% HnBs, 50% ECigs) 12,721 25,390 4,519 3,676 46,305 12.02 44.45 41.70 15.93 23.53
6 Conversion Scenario 4,904 10,498 1,979 1,625 19,007 4.64 18.38 18.26 7.04 9.66
7 Full Conversion Scenario 5,197 11,221 2,099 1,701 20,218 4.91 19.64 19.37 7.37 10.27
B 1 Complete cessation 31,383 56,530 10,692 9,710 108,315 12.41 44.27 46.20 15.94 23.31
3 Complete switch to RRPs (50% HnBs, 50% ECigs) 25,538 46,790 9,104 8,280 89,713 10.10 36.64 39.34 13.60 19.31
6 Conversion Scenario 10,059 19,516 4,077 3,605 37,256 3.98 15.28 17.62 5.92 8.02
7 Full Conversion Scenario 10,549 20,353 4,249 3,766 38,918 4.17 15.94 18.36 6.18 8.38
A+B 1 Complete cessation 47,094 87,266 16,005 14,013 164,377 13.13 47.22 47.10 16.69 24.85
3 Complete switch to RRPs (50% HnBs, 50% ECigs) 38,259 72,180 13,623 11,956 136,018 10.67 39.05 40.09 14.24 20.56
6 Conversion Scenario 14,963 30,014 6,056 5,230 56,263 4.17 16.24 17.82 6.23 8.51
7 Full Conversion Scenario 15,746 31,574 6,348 5,467 59,136 4.39 17.08 18.68 6.51 8.94
Women
A 1 Complete cessation 6,703 5,841 2,592 1,527 16,663 23.66 55.38 51.42 24.18 33.17
3 Complete switch to RRPs (50% HnBs, 50% ECigs) 5,395 4,867 2,210 1,303 13,776 19.04 46.15 43.85 20.63 27.42
6 Conversion Scenario 1,834 1,799 864 506 5,003 6.47 17.05 17.15 8.01 9.96
7 Full Conversion Scenario 1,997 1,958 934 541 5,430 7.05 18.56 18.52 8.56 10.81
B 1 Complete cessation 15,98 13,209 5,264 4,916 39,369 20.66 45.87 51.20 23.60 28.68
3 Complete switch to RRPs (50% HnBs, 50% ECigs) 12,929 11,056 4,467 4,178 32,630 16.71 38.39 43.45 20.06 23.78
6 Conversion Scenario 4,898 4,493 1,934 1,804 13,129 6.33 15.60 18.81 8.66 9.57
7 Full Conversion Scenario 5,146 4,682 2,028 1,878 13,734 6.65 16.26 19.73 9.02 10.01
A+B 1 Complete cessation 22,683 19,050 7,856 6,443 56,032 21.46 48.42 51.27 23.73 29.88
3 Complete switch to RRPs (50% HnBs, 50% ECigs) 18,324 15,923 6,677 5,481 46,406 17.34 40.47 43.58 20.19 24.75
6 Conversion Scenario 6,732 6,292 2,798 2,310 18,132 6.37 15.99 18.26 8.51 9.67
7 Full Conversion Scenario 7,143 6,640 2,962 2,419 19,164 6.76 16.88 19.33 8.91 10.22

Distribution of quit time a by SEG in Germany in 1995.

Sex Age (years) SEG = A Distribution of quit time (years)b SEG = B Distribution of quit time (years)b
<1 1–2 3–5 6–10 11–20 21+ <1 1–2 3–5 6–10 11–20 21+
Men 10–14 99.9 0.1 0 0 0 0 99.9 0.1 0 0 0 0
15–19 69.4 30.6 0 0 0 0 69.4 30.6 0 0 0 0
20–24 38.7 29.8 31.5 0 0 0 51.1 41.7 7.2 0 0 0
25–29 10.7 33.2 47.5 5.4 3.2 0 41.8 23.3 34.8 0 0 0
30–34 13.7 49.1 21.2 11.8 4.2 0 19.5 36.7 14.2 7.6 22.0 0
35–39 12.2 16.2 17.8 26.5 23.7 3.5 29.4 22.3 12.6 22.2 13.6 0
40–44 10.7 14.2 10.7 16.5 40.5 7.3 19.1 15.3 12.3 22.7 26.3 4.4
45–49 15.7 10.7 14.3 14.5 39.1 5.8 14.2 18.7 7.0 17.0 30.4 12.7
50–54 5.8 8.3 10.7 14.5 41.8 18.9 9.1 13.2 23.9 13.8 22.9 17.2
55–59 3.3 6.7 2.7 13.0 25.2 49.0 4.2 11.2 11.4 17.8 27.2 28.1
60–64 4.5 8.4 7.7 6.1 33.6 39.6 5.6 6.4 11.5 8.0 26.9 41.7
65–69 3.4 3.6 3.4 10.2 23.4 56.0 5.2 4.9 3.5 16.6 29.2 40.6
70–74 0 7.3 7.1 1.9 24.6 59.0 5.0 5.9 7.6 10.1 22.7 48.6
75–79 0 2.3 0.8 10.4 19.2 67.1 4.6 0.6 0.4 11.4 25.0 57.9
Women 10–14 99.9 0.1 0 0 0 0 99.9 0.1 0 0 0 0
15–19 60.2 39.8 0 0 0 0 60.2 39.8 0 0 0 0
20–24 44.9 35.3 18.4 1.4 0 0 32.0 28.4 37.6 2.0 0 0
25–29 46.3 32.0 13.9 0.1 7.7 0 20.0 23.6 33.9 22.6 0 0
30–34 9.8 26.3 30.6 28.3 5.0 0 29.0 14.9 19.1 26.0 11.2 0
35–39 11.2 23.0 19.6 18.2 28.0 0 10.2 28.9 11.9 29.5 19.5 0
40–44 12.6 13.4 13.7 13.2 36.0 11.1 25.6 15.1 6.4 13.3 14.8 24.7
45–49 7.3 9.2 10.8 12.7 41.1 19.1 8.5 22.1 8.1 13.0 37.3 11.0
50–54 10.3 9.5 12.2 7.9 34.8 25.2 12.0 12.1 4.2 24.8 32.4 14.5
55–59 7.8 4.8 7.2 13.5 13.0 53.8 25.8 2.3 6.6 11.6 36.1 17.5
60–64 6.1 6.8 7.3 17.6 15.1 47.0 12.3 0.9 10.3 17.1 32.3 27.1
65–69 0.8 27.2 10.3 2.0 14.1 45.5 8.8 8.5 14.9 13.1 21.1 33.7
70–74 0 15.6 0 0.7 35.3 48.3 9.1 8.8 9.2 6.7 22.5 43.8
75–79 0 12.8 0 14.5 12.6 60.1 6.4 3.1 23.6 18.8 28.2 19.9

Annual probabilities of transition between SEGs by sex and age.

Age (years) Transitions from A to B Transitions from B to A
Men Women Men Women
10–14 0.02 0.02 0.0522 0.0371
15–19 0.02 0.02 0.0164 0.0086
20–24 0.02 0.02 0.0719 0.0400
25–29 0.02 0.02 0.0533 0.0484
30–34 0.02 0.02 0.0559 0.0486
35–39 0.02 0.02 0.0586 0.0527
40–44 0.02 0.02 0.0615 0.0574
45–49 0.02 0.02 0.0415 0.0352
50–54 0.02 0.02 0.0371 0.0316
55–59 0.02 0.02 0.0667 0.0327
60–64 0.04 0.04 0.0541 0.0283
65–69 0.04 0.04 0.0505 0.0294
70–74 0.06 0.06 0.0379 0.0114
75–79 0.06 0.06 0.0379 0.0114

Data on population, proportion by SEG and smoking prevalence in Germany in 1995.a

Sex Age (years) Population (hundreds) % in SEG A % in SEG B % Current smokers % Former smokers
SEG = A SEG = B SEG = A SEG = B
Men 10–14 23,112 50.00 50.00 6.12 6.12 0.00 0.00
15–19 21,921 50.00 50.00 26.62 26.62 3.50 3.50
20–24 24,908 41.42 58.58 48.85 61.65 6.41 18.75
25–29 35,543 51.15 48.85 46.66 62.13 10.20 15.07
30–34 37,604 59.96 40.04 44.92 62.39 14.82 13.05
35–39 34,006 55.82 44.18 43.64 62.15 20.03 12.67
40–44 29,154 56.12 43.88 42.96 62.47 26.44 13.43
45–49 25,049 51.81 48.19 40.23 57.05 32.25 21.05
50–54 27,482 45.32 54.68 35.47 44.43 38.60 31.52
55–59 29,221 40.73 59.27 26.90 30.12 45.10 39.24
60–64 20,582 36.66 63.34 18.65 22.09 49.78 42.61
65–69 18,087 31.95 68.05 16.81 19.45 52.09 45.88
70–74 12,280 29.04 70.96 13.75 14.92 52.90 49.50
75–79 5,812 28.72 71.28 9.90 9.93 52.44 53.37
10–79 344,761 47.80 52.20 35.48 42.17 23.21 23.96
Population b 10–79 344,761 164,798 179,763 58,463 75,896 38,258 43,122
Mean age 10–79 40.92 38.91 42.76 37.82 39.52 49.93 53.82
Women 10–14 21,928 50.00 50.00 5.39 5.39 0.00 0.00
15–19 20,788 50.00 50.00 19.73 19.73 0.16 0.16
20–24 23,618 48.57 51.43 27.85 51.33 22.96 1.96
25–29 33,241 57.39 42.61 30.24 51.30 21.54 8.05
30–34 34,681 61.41 38.59 32.03 51.23 21.85 12.69
35–39 31,271 63.68 36.32 33.05 50.82 23.53 15.94
40–44 27,580 60.62 39.38 33.87 51.95 28.09 17.78
45–49 24,142 50.59 49.41 31.01 41.55 25.84 18.09
50–54 26,958 40.67 59.33 25.69 28.72 20.30 14.89
55–59 29,511 39.71 60.29 19.18 18.52 17.03 9.49
60–64 21,703 29.16 70.84 15.75 10.96 19.77 6.50
65–69 22,609 18.91 80.09 14.54 6.29 23.12 8.21
70–74 21,886 16.77 83.23 12.46 3.33 21.46 10.04
75–79 12,226 17.95 82.05 10.52 2.26 16.35 12.74
10–79 352,142 45.78 54.22 25.95 26.67 19.58 9.78
Population b 10–79 352,142 161,201 190,941 41,829 50,930 31,559 18,674
Mean age 10–79 43.25 38.47 47.29 38.10 38.74 41.52 51.54

Monthly tobacco transition probabilities (per million) by SEG in the Null Scenario for Germany.

SEG A SEG B
Period (years) Age (years) Initiation (PNC) Quitting (PCF) Re-initiation (PFC) Initiation (PNC) Quitting (PCF) Re-initiation (PFC)
Men Women Men Women Men Women Men Women Men Women Men Women
1–5 10–14 4,296 3,462 2,446 1,454 1,166 695 4,296 3,462 2,446 1,454 1,166 695
15–19 5,578 5,948 4,293 18,310 2,035 8,325 13,030 9,824 4,406 5,752 2,088 2,714
20–24 2,560 2,712 4,631 2,808 2,193 1,337 5,277 2,470 964 3,630 461 1,724
25–29 173 1,301 3,411 2,390 1,621 1,139 2,432 1,663 1,061 2,619 508 1,247
30–34 516 638 3,695 2,532 1,755 1,207 778 723 1,251 1,770 599 845
35–39 0 0 4,007 2,891 1,901 1,376 0 0 1,474 981 705 470
40–44 0 0 3,569 2,089 1,696 997 0 0 2,506 1,935 595 319
45–49 0 0 4,041 2,396 1,434 855 0 0 3,506 1,903 414 181
50–54 0 0 5,040 3,463 1,184 504 0 0 3,733 1,789 220 128
55–59 0 0 4,487 6,368 527 404 0 0 2,756 3,032 163 108
60–64 0 0 2,153 6,226 256 305 0 0 2,859 7,788 84 70
65–69 0 0 2,252 3,685 134 195 0 0 4,057 10,198 60 46
70–74 0 0 2,673 3,020 79 125 0 0 5,292 14,584 39 32
75–79 0 0 2,673 3,020 79 125 0 0 5,292 14,584 39 32
6–10 10–14 3,654 2,986 2,063 2,210 985 1,054 3,654 2,986 2,063 2,210 985 1,054
15–19 4,816 4,256 7,804 14,719 3,660 6,766 9,496 10,212 3,177 9,730 1,511 4,537
20–24 978 1,993 4,476 3,470 2,120 1,649 3,359 2,024 1,323 3,327 633 1,582
25–29 320 967 4,047 3,044 1,920 1,448 1,179 1,197 1,238 2,250 592 1,073
30–34 461 477 4,158 3,100 1,972 1,475 760 380 1,640 1,462 784 699
35–39 0 0 4,044 3,056 1,919 1,454 0 0 1,954 937 933 449
40–44 0 0 3,146 2,798 1,496 1,201 0 0 2,219 1,468 791 354
45–49 0 0 3,751 3,440 1,333 1,059 0 0 2,907 1,588 684 189
50–54 0 0 4,358 4,121 1,027 786 0 0 3,276 1,900 430 113
55–59 0 0 3,865 5,097 455 495 0 0 2,947 2,848 316 84
60–64 0 0 2,627 4,689 311 462 0 0 2,853 4,239 153 62
65–69 0 0 2,680 3,966 159 364 0 0 3,824 4,840 101 35
70–74 0 0 3,144 4,767 93 205 0 0 4,687 5,286 61 22
75–79 0 0 3,144 4,767 93 205 0 0 4,687 5,286 61 22
11+ 10–14 2,883 2,072 1,840 3,593 879 1,706 2,883 2,072 1,840 3,593 879 1,706
15–19 4,438 3,679 14,553 12,981 6,681 5,999 6,837 11,864 1,340 17,133 640 7,807
20–24 374 1,186 5,489 3,933 2,593 1,865 1,323 1,495 1,532 2,845 732 1,355
25–29 463 573 5,296 3,823 2,503 1,815 1,852 678 2,093 1,715 998 819
30–34 409 283 5,029 3,931 2,379 1,866 1,718 190 2,458 1,141 1,171 546
35–39 0 0 4,385 3,091 2,078 1,470 0 0 2,727 874 1,299 419
40–44 0 0 2,750 3,681 1,309 1,146 0 0 1,856 1,166 886 301
45–49 0 0 3,376 5,215 1,085 694 0 0 2,293 1,958 819 233
50–54 0 0 3,432 4,989 703 499 0 0 3,219 2,218 646 132
55–59 0 0 3,139 4,394 318 436 0 0 3,077 2,882 305 85
60–64 0 0 2,893 3,412 278 340 0 0 3,259 2,316 160 69
65–69 0 0 3,015 4,064 142 203 0 0 3,821 2,463 94 36
70–74 0 0 3,571 7,872 83 148 0 0 4,223 2,245 52 33
75–79 0 0 3,571 7,872 79 125 0 0 4,223 2,245 39 32

YLS (thousands) by age 75 by SEG over follow-up in Germany in the Alternative Scenarios.

SEG Sc Scenario Men Women
LC IHD Stroke COPD All four diseases LC IHD Stroke COPD All four diseases
A 1 Complete cessation 194 563 87 36 880 116 114 55 19 305
3 Complete switch to RRPs (50% HnBs, 50% ECigs) 153 457 74 30 714 92 94 47 16 250
6 Conversion Scenario 55 183 31 12 281 30 34 18 62 88
7 Full Conversion Scenario 59 198 33 13 303 33 38 19 66 97
B 1 Complete cessation 312 855 142 66 1,374 175 175 77 37 465
3 Complete switch to RRPs (50% HnBs, 50% ECigs) 247 689 119 56 1,112 138 143 65 32 378
6 Conversion Scenario 92 277 51 24 444 48 55 26 13 143
7 Full Conversion Scenario 96 290 53 25 464 51 58 28 14 151
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