Importance:
Raising the price of cigarettes by increasing taxation has been associated with
improved perinatal and child health outcomes. Transnational tobacco companies have
sought to undermine tobacco tax policy by adopting pricing strategies which maintain the
availability of budget cigarettes.
Objective
:
To assess
associations
between
median cigarette prices, cigarette
price
differentials
and
infant mortality
across Europe
.
Design
:
Longitudinal ecological study of regions within the European Union
.
Setting
:
23 European countries; 2004
–
2014 (data from
276 sub
-
national regions
).
Participants
:
Infant populations in relevant countries.
Interventions
:
M
edian cigarette prices and the differential between these and minimum
cigarette prices
were obtained from Euromonitor International
.
Pricing d
ifferential
s
were
calculated
as
the
proportion
s
(%
) obtained by dividing minimum by median cigarette price.
Prices
were adjusted for inflation.
Main outcome measure
: Annual infant mortality rates. Associations were assessed using
linear fixed
-
effect panel regression models
adjusted for
smoke
-
free policies; G
ross
D
omestic
P
roduct
; unemployment rate;
education; materna
l age; and underlining temporal trends.
Results
:
A €1 per pack increase in the median cigarette price was associated with a decline
of
-
0.23 deaths per 1,000 live births in the same year (95% Confidence Interval [CI]:
-
0.37 to
-
0.09) and
-
0.16 per 1,000 l
ive births the following year (95% CI:
-
0.30 to
-
0.03). An increase
of 10% in the price differential between median and minimum priced cigarettes was associated with an increase of 0.07 deaths per 1,000 live births (95% CI: 0.01 to 0.13) the
following year
.
C
igarette price increases
across 23 European countries between 2004 and
2014 were associated with 9
,
208
(95% CI: 8,
601
to 9,
814
) fewer infant deaths; 3,
195
(95%
CI: 3,
017
to 3,
372
)
infant deaths
c
ould have been avoided
had there been
no differential
between median and the minimum
priced
cigarette
s during this period
.
Conclusions and relevance:
Higher cigarette prices were associated with reduced infant
mortality, while increased cigarette price differentials were associated with hig
her infant
mortality in the European Union. Combined with other evidence this research suggests that
legislators should implement tobacco tax and price control measures which eliminate budget
cigarettes.