The effect of socio-economic inequalities: modelling of population health impact of introducing reduced-risk tobacco products into Germany
Education, income and occupation are the most commonly used descriptors of social inequalities in health. The socio-economic status (SES) of individuals (or groups of individuals) has proven to be important when describing and understanding smoking prevalence in a population. Indicators such as low education level and low income have been associated with higher smoking prevalence, higher exposure to smoking environments, and lower success in quitting smoking. Prevalence of tobacco consumption is high in Germany (28.3 %); it is markedly uneven across the population and strongly influenced by SES. A Population Health Impact Model (PHIM) was used to estimate the impact of introducing a reduced-risk product* (RRP) in Germany and its effect on socio-economic inequalities based on education and income. Input data on smoking prevalence, quit times, and mortality were obtained from widely used German data (publicly available sources and recently published research). Various simulations were carried out to understand the effect of an RRP introduction on major smoking-related diseases (lung cancer, ischemic heart disease, chronic obstructive pulmonary disease, and stroke) in the German population. The simulations were performed for different age, gender, and SES sub-groups over a 20-year period. Study results can be indicative of the outcome of introducing and switching to an RRP within a population characterized by groups of individuals from different SES and in helping to discern the impact of an RRP on the stratified socio-economic context of a country.
* "Reduced-risk products" or "RRPs" is the term we use to refer to products that present, are likely to present, or have the potential to present less risk of harm to smokers who switch to these products versus continued smoking. We have a range of RRPs in various stages of development, scientific assessment, and commercialisation.