Abstract
Background: Māori (Indigenous peoples of Aotearoa New Zealand [A/NZ]) have high tobacco smoking rates, a legacy of colonisation. We estimated the health gains and inequality reductions of the A/NZ Government’s proposed endgame strategy implemented in 2023 of denicotinising tobacco, reducing retail outlets by 95%, and a making it illegal for people born after 2006 to purchase tobacco (tobacco-free generation).
Methods: A Markov smoking-vaping cohort model was parameterised for business-as-usual (BAU) using Health Survey data projections, and for endgame strategies using research and expert knowledge inputs. The difference in smoking and vaping prevalence between BAU and each endgame policies was merged with incidence rate ratios for 16 tobacco-related diseases and fed into a proportional multistate lifetable model to estimate future health-adjusted life years (HALYs) and mortality rates.
Findings: The combined package of strategies reduced adult smoking prevalence from 31.8% in 2022 to 7.6% in 2025 for Māori, and 11.8% to 2.8% for non-Māori. The 5% smoking prevalence target was achieved in 2026 and 2027 for Māori males and females, respectively. The HALY gains for the combined package (compared to BAU) over the remaining lifespan of the A/NZ population alive in 2020 (5.08 million) was 598,000 (95%UI: 517,000 to 698,000; 3% discount rate). The denicotinisation strategy alone achieved 97% of these HALYs, the retail strategy 19%, and tobacco-free generation 12%. The per capita HALY gains for the combined package for Māori were 4.75 and 2.14 times higher than for non-Māori females and males, respectively. The absolute difference between Māori and non-Māori all-cause mortality for 45+ year olds in 2040 was 22.9% (19.9% to 26.2%) less for females under the combined packaged compared to BAU, and 9.6% (8.4% to 11.0%) less for males.
Interpretation: A tobacco endgame strategy – especially denicotinisation – could dramatically reduce health inequities.
Methods: A Markov smoking-vaping cohort model was parameterised for business-as-usual (BAU) using Health Survey data projections, and for endgame strategies using research and expert knowledge inputs. The difference in smoking and vaping prevalence between BAU and each endgame policies was merged with incidence rate ratios for 16 tobacco-related diseases and fed into a proportional multistate lifetable model to estimate future health-adjusted life years (HALYs) and mortality rates.
Findings: The combined package of strategies reduced adult smoking prevalence from 31.8% in 2022 to 7.6% in 2025 for Māori, and 11.8% to 2.8% for non-Māori. The 5% smoking prevalence target was achieved in 2026 and 2027 for Māori males and females, respectively. The HALY gains for the combined package (compared to BAU) over the remaining lifespan of the A/NZ population alive in 2020 (5.08 million) was 598,000 (95%UI: 517,000 to 698,000; 3% discount rate). The denicotinisation strategy alone achieved 97% of these HALYs, the retail strategy 19%, and tobacco-free generation 12%. The per capita HALY gains for the combined package for Māori were 4.75 and 2.14 times higher than for non-Māori females and males, respectively. The absolute difference between Māori and non-Māori all-cause mortality for 45+ year olds in 2040 was 22.9% (19.9% to 26.2%) less for females under the combined packaged compared to BAU, and 9.6% (8.4% to 11.0%) less for males.
Interpretation: A tobacco endgame strategy – especially denicotinisation – could dramatically reduce health inequities.
| Original language | English |
|---|---|
| Publisher | SSRN |
| Number of pages | 31 |
| DOIs | |
| Publication status | Published - 24 May 2022 |
| Externally published | Yes |
Publication series
| Name | SSRN Electronic Journal |
|---|---|
| ISSN (Electronic) | 1556-5068 |
Keywords
- tobacco endgame
- Māori health
- health inequity
- health policy simulation
