Study finds association between cigarette tax and reduced infant deaths

Raising taxes on tobacco is associated with a reduction in neonatal and infant mortality, according to an analysis of 159 countries published this week in the open-access journal PLOS Global Public Health by Anthony Laverty of Imperial College London, UK, and colleagues.

Exposure of pregnant women and babies to smoking and second-hand smoke is known to increase the risks of neonatal and infant mortality. Raising taxation on tobacco has been shown to be the most effective measure of reducing tobacco use and associated health risks, especially among low-income populations. A tobacco tax rate of 75% or greater is recommended by the World Health Organization (WHO).

In the new study, the researchers used data spanning 2008 through 2018 from 159 countries on neonatal and infant mortality, tobacco taxation, and other related variables including gross domestic product, fertility rate, education and access to drinking water.

On average across all countries studied, the neonatal mortality rate was 14.4 and the infant mortality rate was 24.9 per 1,000 live births. Worldwide between 2008-2018, the average neonatal and infant mortality rates were 14.4 and 24.9 deaths per 1,000 live births, respectively. These rates were higher in LMICs than HICs – with 33 children aged under one, including 19 newborns, in every 1,000 dying each year in LMICs, compared to 4 newborns and 6 under-ones in every 1,000 in HICs. The average total tax on cigarettes relative to retail price was 49.1%, with only 11.2% of low- and middle-income countries and 42.1% of high-income countries achieving the recommended 75% taxation. The team found that a ten percentage-point increase in total cigarette tax was associated with a 2.6% decrease in neonatal mortality (95% CI 1.9- 3.2) and a 1.9% decrease in infant mortality (95% CI 1.3- 2.6). Based on the findings, an estimated 231,220 (95% CI 152,658- 307,655) infant deaths, including 181,970 (95% CI: 135,679 to 226,377) neonatal deaths, might have been averted in 2018 if all countries had at least a 75% cigarette tax rate.

The study was not able to control for all potential confounders, but the authors suggest that the health impacts of taxation are likely mediated through decreases in prenatal and postnatal second-hand smoke exposure and decreased smoking during pregnancy.

The authors add: “We know that tobacco smoking continues to kill more than 8 million people per year, and that increasing taxes on tobacco is an effective way to bring this number down. This study highlights that if everywhere taxed tobacco at the levels recommended by the WHO, we would substantially reduce neonatal and infant deaths.”