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Infant mortality falls in EU nations as cigarette prices rise

Legislators should act on tobacco tax and price control to eliminate budget cigarettes

Louise Prime

Wednesday, 20 September 2017

Higher median cigarette prices were associated with reduced infant mortality in European Union countries between 2004 and 2014, and bigger differences in price between premium and budget cigarettes were associated with higher infant mortality, according to research* published by JAMA Pediatrics. Its authors said their findings suggest that legislators should implement tobacco tax and price control measures that eliminate budget cigarettes.

Researchers led from Imperial College, London, were concerned that transnational tobacco companies have sought to undermine tobacco tax policy by adopting pricing strategies that maintain the availability of budget cigarettes, and by the potential effects of this policy. They conducted a longitudinal, ecological study of infant populations in 23 EU countries (comprising 276 subnational regions), over 11 years from 1 January 2004, to assess associations between median cigarette prices, cigarette price differentials between brands, and infant mortality across the EU.

Over the study period, infant mortality fell in all 23 countries; the median rate was 4.4 deaths per 1,000 live births in 2004 and 3.5 per 1,000 live births in 2014. Both median and minimum cigarette prices increased in all 23 countries during the study period.

The researchers reported an association between increases in the median price of cigarettes and reductions in infant mortality across Europe from 2004 to 2014. Among the more than 53.7 million live births during this period, a €1 per pack increase in the median cigarette price was associated with 0.23 fewer deaths per 1,000 live births in the same year and a further 0.16 fewer deaths per 1,000 live births in the following year.

They also found that a 10% increase in the difference in price between median-priced and minimum-priced cigarette price was associated with 0.07 more deaths per 1,000 live births the following year. They calculated that 3,195 infant deaths could have been avoided had there been no cost differential between the median-priced and minimum-priced cigarettes during the study period.

They noted that their study was limited in part by being designed as an ecological analysis, so they could not make individual inferences, and also by there being missing data for some regions and years.

But they concluded: “Higher cigarette prices were associated with reduced infant mortality, while increased cigarette price differentials were associated with higher infant mortality in the European Union. Combined with other evidence, this research suggests that legislators should implement tobacco tax and price control measures that eliminate budget cigarettes.”


* Filippidis FT, Laverty AA, Hone T, et al. Association of cigarette price differentials with infant mortality in 23 European Union countries. JAMA Pediatr. Published online September 18, 2017. doi:10.1001/jamapediatrics.2017.2536.

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