© 2004 by European Journal of Public Health
Tobacco |
Modelling future mortality reduction through smoking cessation in the European Union
Ina Mulder1,2, Rudolf T. Hoogenveen2,*, Henriëtte A. Smit2 and H. Bas Bueno de Mesquita31 Comprehensive Cancer Centre Amsterdam (IKA), Amsterdam, The Netherlands 2 Center for Prevention and Health Services Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands 3 Center for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
Background: To assess public health relevance of targets on tobacco smoking, information is needed on the decline in future mortality following smoking cessation. WHO's Health for All (HFA) and other targets on tobacco smoking in the European Union (EU) were therefore simulated. Methods: A computer simulation model, Markov multi-state type, was developed using published age- and sex-specific information on population sizes, smoking prevalences, total and cause-specific mortality rates and corresponding relative risks for ex- and current smokers. The probabilities to start and quit smoking (transition rates) were estimated. Targets on smoking cessation included WHO's HFA target (country-specific smoking prevalence is reduced to 20% by 2015), and a theoretical maximum target (all smokers quit instantly). Simulation of these targets was based on changes in transition rates for smoking behaviour. For each target, the cumulated number of all-cause and cause-specific deaths between 1994 and 2015 was estimated for each EU member state. Then, the absolute and relative reduction in the number of deaths compared to a reference scenario, in which transition rates for smoking behaviour remained constant, were estimated for the EU as a whole. Results: WHO's HFA target was expected to give a total mortality reduction by 2015 of 2.5% (around 1.1 million deaths) among men and 0.8% (almost 350,000 deaths) among women in the EU. Overall, the expected mortality declines in the HFA target were about 40–50% (men) and 30% (women) of the expected declines in the maximum target. The largest impact of the HFA target would be reached for lung cancer mortality. Conclusions: These results emphasize the need for policymakers in each EU member state to put strong effort into encouraging smokers to quit smoking.
Keywords: European Union, future mortality, public health modelling, smoking cessation
Received 21 March 2002. Accepted 16 July 2002.
* Correspondence: R.T. Hoogenveen, MSc, Center for Prevention and Health Services Research, National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands, tel. +31 30 274 3244, fax +31 30 274 4407, e-mail: rudolf.hoogenveen{at}rivm.nl
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