Does the Impact of Tobacco Taxes Vary by Race and Gender? Taxes, Smoking, and Coronary Heart Disease Mortality in the United States, 2005-2016

Abstract

Tobacco taxes have reduced smoking and CHD mortality, yet few studies have examined heterogeneity of these associations by race and gender. We constructed a yearly panel (2005-2016) that included age-adjusted cigarette smoking prevalence and CHD mortality rates across all 50 US States and the District of Columbia using the Behavioral Risk Factor Surveillance System and CDC’s Wide-ranging Online Data for Epidemiological Research. We examined associations between changes in total cigarette excise taxes (i.e., federal and state) and changes in smoking prevalence and CHD mortality, using linear regression models with state and year fixed effects. Each dollar of tobacco tax was associated with a reduction in age-adjusted smoking prevalence 1 year later of -0.4 [95% CIs: -0.6, -0.2] percentage points; and a relative reduction in the rate of CHD mortality 2 years later of -2.0% [95% CIs: -3.5%, -0.5%], or -5 deaths/100,000 in absolute terms. Associations for smoking prevalence were strongest among Black non-Hispanic women (-1.2 [95% CIs: -1.6, -0.8] percentage points), but did not differ by race and gender for CHD mortality. These findings suggest that tobacco taxation is an effective intervention for reducing smoking prevalence and CHD mortality among White and Black non-Hispanic populations in the United States.

Note:
Funding declaration: None

Conflicts of Interest: None

Ethical Approval: This study was approved by the Boston University Medical Center IRB under IRB# 39516.

Keywords: Smoking, Health Policy, tobacco control, Taxation, Racial Disparities, Coronary Heart Disease