lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Simulation Modelling of Tobacco Endgame Interventions and Their Impact on Māori:Non-Māori Health Inequity in Aotearoa-New Zealand

31 Pages Posted: 24 May 2022

See all articles by Driss Ait Ouakrim

Driss Ait Ouakrim

The University of Melbourne

Tim Wilson

The University of Melbourne - Centre for Epidemiology and Biostatistics

Andrew Waa

University of Otago

Raglan Maddox

Australian National University (ANU)

Hassan Andrabi

The University of Melbourne - Centre for Epidemiology and Biostatistics

Shiva Raj Mishra

The University of Melbourne

Jennifer Summers

University of Otago

Coral Gartner

University of Queensland - School of Public Health

Raymond Lovett

Australian National University (ANU)

Richard Edwards

University of Otago - Department of Public Health

Nick Wilson

University of Otago - Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme

Tony Blakely

University of Melbourne - Population Interventions Unit; The University of Melbourne - Centre for Epidemiology and Biostatistics

More...

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.

Funding Information: This study was supported by the New Zealand Ministry of Health.

Declaration of Interests: None.

Keywords: Tobacco endgame, Māori health, health inequity, health policy simulation

Suggested Citation

Ait Ouakrim, Driss and Wilson, Tim and Waa, Andrew and Maddox, Raglan and Andrabi, Hassan and Raj Mishra, Shiva and Summers, Jennifer and Gartner, Coral and Lovett, Raymond and Edwards, Richard and Wilson, Nick and Blakely, Tony, Simulation Modelling of Tobacco Endgame Interventions and Their Impact on Māori:Non-Māori Health Inequity in Aotearoa-New Zealand. Available at SSRN: https://ssrn.com/abstract=4118872 or http://dx.doi.org/10.2139/ssrn.4118872

Driss Ait Ouakrim

The University of Melbourne ( email )

Parkville, 3010
Australia

Tim Wilson

The University of Melbourne - Centre for Epidemiology and Biostatistics ( email )

Andrew Waa

University of Otago ( email )

P.O. Box 56
Dunedin, 9010
New Zealand

Raglan Maddox

Australian National University (ANU) ( email )

Hassan Andrabi

The University of Melbourne - Centre for Epidemiology and Biostatistics ( email )

Shiva Raj Mishra

The University of Melbourne ( email )

Parkville, 3010
Australia

Jennifer Summers

University of Otago ( email )

P.O. Box 56
Dunedin, Otago 9010
New Zealand

Coral Gartner

University of Queensland - School of Public Health ( email )

Queensland
Australia

Raymond Lovett

Australian National University (ANU) ( email )

Richard Edwards

University of Otago - Department of Public Health ( email )

New Zealand

Nick Wilson

University of Otago - Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme ( email )

New Zealand

Tony Blakely (Contact Author)

University of Melbourne - Population Interventions Unit ( email )

Melbourne
Australia

The University of Melbourne - Centre for Epidemiology and Biostatistics ( email )

Click here to go to TheLancet.com

Paper statistics

Downloads
79
Abstract Views
395
PlumX Metrics