Estimated Public Health Gains From Smokers in Germany Switching to Reduced-Risk Alternatives: Results From Population Health Impact Modelling by Socioeconomic Group

Rytsar, Romana; Djurdjevic, Smilja; Nussbaum, Alexander K.; Kaul, Ashok; Bennewitz, Emanuel; Lee, Peter N.; Fry, John S.

doi:10.2478/cttr-2022-0005

Figures & Tables

Comparison of Null Scenario and derived estimates of current smoking prevalence.

Nicotine usage in the Conversion Scenario.

DDs in the Conversion Scenario over the whole follow-up period.

YLS by Scenario and SEG over the whole follow-up period.

Drop in deaths by SEG over the follow-up period in Germany in the Alternative Scenarios_

SEG	Sc	Sex/Scenario	DD (n)					DD (%)

			LC	IHD	Stroke	COPD	All four diseases	LC	IHD	Stroke	COPD	All four diseases
Men
A	1	Complete cessation	15,711	30,736	5,313	4,303	56,062	14.85	53.81	49.02	18.65	28.48
	3	Complete switch to RRPs (50% HnBs, 50% ECigs)	12,721	25,390	4,519	3,676	46,305	12.02	44.45	41.70	15.93	23.53
	6	Conversion Scenario	4,904	10,498	1,979	1,625	19,007	4.64	18.38	18.26	7.04	9.66
	7	Full Conversion Scenario	5,197	11,221	2,099	1,701	20,218	4.91	19.64	19.37	7.37	10.27
B	1	Complete cessation	31,383	56,530	10,692	9,710	108,315	12.41	44.27	46.20	15.94	23.31
	3	Complete switch to RRPs (50% HnBs, 50% ECigs)	25,538	46,790	9,104	8,280	89,713	10.10	36.64	39.34	13.60	19.31
	6	Conversion Scenario	10,059	19,516	4,077	3,605	37,256	3.98	15.28	17.62	5.92	8.02
	7	Full Conversion Scenario	10,549	20,353	4,249	3,766	38,918	4.17	15.94	18.36	6.18	8.38
A+B	1	Complete cessation	47,094	87,266	16,005	14,013	164,377	13.13	47.22	47.10	16.69	24.85
	3	Complete switch to RRPs (50% HnBs, 50% ECigs)	38,259	72,180	13,623	11,956	136,018	10.67	39.05	40.09	14.24	20.56
	6	Conversion Scenario	14,963	30,014	6,056	5,230	56,263	4.17	16.24	17.82	6.23	8.51
	7	Full Conversion Scenario	15,746	31,574	6,348	5,467	59,136	4.39	17.08	18.68	6.51	8.94
Women
A	1	Complete cessation	6,703	5,841	2,592	1,527	16,663	23.66	55.38	51.42	24.18	33.17
	3	Complete switch to RRPs (50% HnBs, 50% ECigs)	5,395	4,867	2,210	1,303	13,776	19.04	46.15	43.85	20.63	27.42
	6	Conversion Scenario	1,834	1,799	864	506	5,003	6.47	17.05	17.15	8.01	9.96
	7	Full Conversion Scenario	1,997	1,958	934	541	5,430	7.05	18.56	18.52	8.56	10.81
B	1	Complete cessation	15,98	13,209	5,264	4,916	39,369	20.66	45.87	51.20	23.60	28.68
	3	Complete switch to RRPs (50% HnBs, 50% ECigs)	12,929	11,056	4,467	4,178	32,630	16.71	38.39	43.45	20.06	23.78
	6	Conversion Scenario	4,898	4,493	1,934	1,804	13,129	6.33	15.60	18.81	8.66	9.57
	7	Full Conversion Scenario	5,146	4,682	2,028	1,878	13,734	6.65	16.26	19.73	9.02	10.01
A+B	1	Complete cessation	22,683	19,050	7,856	6,443	56,032	21.46	48.42	51.27	23.73	29.88
	3	Complete switch to RRPs (50% HnBs, 50% ECigs)	18,324	15,923	6,677	5,481	46,406	17.34	40.47	43.58	20.19	24.75
	6	Conversion Scenario	6,732	6,292	2,798	2,310	18,132	6.37	15.99	18.26	8.51	9.67
	7	Full Conversion Scenario	7,143	6,640	2,962	2,419	19,164	6.76	16.88	19.33	8.91	10.22

Distribution of quit time a by SEG in Germany in 1995_

Sex	Age (years)	SEG = A Distribution of quit time (years)^b						SEG = B Distribution of quit time (years)^b

		<1	1–2	3–5	6–10	11–20	21+	<1	1–2	3–5	6–10	11–20	21+
Men	10–14	99.9	0.1	0	0	0	0	99.9	0.1	0	0	0	0
	15–19	69.4	30.6	0	0	0	0	69.4	30.6	0	0	0	0
	20–24	38.7	29.8	31.5	0	0	0	51.1	41.7	7.2	0	0	0
	25–29	10.7	33.2	47.5	5.4	3.2	0	41.8	23.3	34.8	0	0	0
	30–34	13.7	49.1	21.2	11.8	4.2	0	19.5	36.7	14.2	7.6	22.0	0
	35–39	12.2	16.2	17.8	26.5	23.7	3.5	29.4	22.3	12.6	22.2	13.6	0
	40–44	10.7	14.2	10.7	16.5	40.5	7.3	19.1	15.3	12.3	22.7	26.3	4.4
	45–49	15.7	10.7	14.3	14.5	39.1	5.8	14.2	18.7	7.0	17.0	30.4	12.7
	50–54	5.8	8.3	10.7	14.5	41.8	18.9	9.1	13.2	23.9	13.8	22.9	17.2
	55–59	3.3	6.7	2.7	13.0	25.2	49.0	4.2	11.2	11.4	17.8	27.2	28.1
	60–64	4.5	8.4	7.7	6.1	33.6	39.6	5.6	6.4	11.5	8.0	26.9	41.7
	65–69	3.4	3.6	3.4	10.2	23.4	56.0	5.2	4.9	3.5	16.6	29.2	40.6
	70–74	0	7.3	7.1	1.9	24.6	59.0	5.0	5.9	7.6	10.1	22.7	48.6
	75–79	0	2.3	0.8	10.4	19.2	67.1	4.6	0.6	0.4	11.4	25.0	57.9
Women	10–14	99.9	0.1	0	0	0	0	99.9	0.1	0	0	0	0
	15–19	60.2	39.8	0	0	0	0	60.2	39.8	0	0	0	0
	20–24	44.9	35.3	18.4	1.4	0	0	32.0	28.4	37.6	2.0	0	0
	25–29	46.3	32.0	13.9	0.1	7.7	0	20.0	23.6	33.9	22.6	0	0
	30–34	9.8	26.3	30.6	28.3	5.0	0	29.0	14.9	19.1	26.0	11.2	0
	35–39	11.2	23.0	19.6	18.2	28.0	0	10.2	28.9	11.9	29.5	19.5	0
	40–44	12.6	13.4	13.7	13.2	36.0	11.1	25.6	15.1	6.4	13.3	14.8	24.7
	45–49	7.3	9.2	10.8	12.7	41.1	19.1	8.5	22.1	8.1	13.0	37.3	11.0
	50–54	10.3	9.5	12.2	7.9	34.8	25.2	12.0	12.1	4.2	24.8	32.4	14.5
	55–59	7.8	4.8	7.2	13.5	13.0	53.8	25.8	2.3	6.6	11.6	36.1	17.5
	60–64	6.1	6.8	7.3	17.6	15.1	47.0	12.3	0.9	10.3	17.1	32.3	27.1
	65–69	0.8	27.2	10.3	2.0	14.1	45.5	8.8	8.5	14.9	13.1	21.1	33.7
	70–74	0	15.6	0	0.7	35.3	48.3	9.1	8.8	9.2	6.7	22.5	43.8
	75–79	0	12.8	0	14.5	12.6	60.1	6.4	3.1	23.6	18.8	28.2	19.9

Annual probabilities of transition between SEGs by sex and age_

Age (years)	Transitions from A to B		Transitions from B to A

	Men	Women	Men	Women
10–14	0.02	0.02	0.0522	0.0371
15–19	0.02	0.02	0.0164	0.0086
20–24	0.02	0.02	0.0719	0.0400
25–29	0.02	0.02	0.0533	0.0484
30–34	0.02	0.02	0.0559	0.0486
35–39	0.02	0.02	0.0586	0.0527
40–44	0.02	0.02	0.0615	0.0574
45–49	0.02	0.02	0.0415	0.0352
50–54	0.02	0.02	0.0371	0.0316
55–59	0.02	0.02	0.0667	0.0327
60–64	0.04	0.04	0.0541	0.0283
65–69	0.04	0.04	0.0505	0.0294
70–74	0.06	0.06	0.0379	0.0114
75–79	0.06	0.06	0.0379	0.0114

Data on population, proportion by SEG and smoking prevalence in Germany in 1995_a

Sex	Age (years)	Population (hundreds)	% in SEG A	% in SEG B	% Current smokers		% Former smokers

					SEG = A	SEG = B	SEG = A	SEG = B
Men	10–14	23,112	50.00	50.00	6.12	6.12	0.00	0.00
	15–19	21,921	50.00	50.00	26.62	26.62	3.50	3.50
	20–24	24,908	41.42	58.58	48.85	61.65	6.41	18.75
	25–29	35,543	51.15	48.85	46.66	62.13	10.20	15.07
	30–34	37,604	59.96	40.04	44.92	62.39	14.82	13.05
	35–39	34,006	55.82	44.18	43.64	62.15	20.03	12.67
	40–44	29,154	56.12	43.88	42.96	62.47	26.44	13.43
	45–49	25,049	51.81	48.19	40.23	57.05	32.25	21.05
	50–54	27,482	45.32	54.68	35.47	44.43	38.60	31.52
	55–59	29,221	40.73	59.27	26.90	30.12	45.10	39.24
	60–64	20,582	36.66	63.34	18.65	22.09	49.78	42.61
	65–69	18,087	31.95	68.05	16.81	19.45	52.09	45.88
	70–74	12,280	29.04	70.96	13.75	14.92	52.90	49.50
	75–79	5,812	28.72	71.28	9.90	9.93	52.44	53.37
	10–79	344,761	47.80	52.20	35.48	42.17	23.21	23.96
Population ^b	10–79	344,761	164,798	179,763	58,463	75,896	38,258	43,122
Mean age	10–79	40.92	38.91	42.76	37.82	39.52	49.93	53.82
Women	10–14	21,928	50.00	50.00	5.39	5.39	0.00	0.00
	15–19	20,788	50.00	50.00	19.73	19.73	0.16	0.16
	20–24	23,618	48.57	51.43	27.85	51.33	22.96	1.96
	25–29	33,241	57.39	42.61	30.24	51.30	21.54	8.05
	30–34	34,681	61.41	38.59	32.03	51.23	21.85	12.69
	35–39	31,271	63.68	36.32	33.05	50.82	23.53	15.94
	40–44	27,580	60.62	39.38	33.87	51.95	28.09	17.78
	45–49	24,142	50.59	49.41	31.01	41.55	25.84	18.09
	50–54	26,958	40.67	59.33	25.69	28.72	20.30	14.89
	55–59	29,511	39.71	60.29	19.18	18.52	17.03	9.49
	60–64	21,703	29.16	70.84	15.75	10.96	19.77	6.50
	65–69	22,609	18.91	80.09	14.54	6.29	23.12	8.21
	70–74	21,886	16.77	83.23	12.46	3.33	21.46	10.04
	75–79	12,226	17.95	82.05	10.52	2.26	16.35	12.74
	10–79	352,142	45.78	54.22	25.95	26.67	19.58	9.78
Population ^b	10–79	352,142	161,201	190,941	41,829	50,930	31,559	18,674
Mean age	10–79	43.25	38.47	47.29	38.10	38.74	41.52	51.54

Monthly tobacco transition probabilities (per million) by SEG in the Null Scenario for Germany_

		SEG A						SEG B

Period (years)	Age (years)	Initiation (P_NC)		Quitting (P_CF)		Re-initiation (P_FC)		Initiation (P_NC)		Quitting (P_CF)		Re-initiation (P_FC)

		Men	Women	Men	Women	Men	Women	Men	Women	Men	Women	Men	Women
1–5	10–14	4,296	3,462	2,446	1,454	1,166	695	4,296	3,462	2,446	1,454	1,166	695
	15–19	5,578	5,948	4,293	18,310	2,035	8,325	13,030	9,824	4,406	5,752	2,088	2,714
	20–24	2,560	2,712	4,631	2,808	2,193	1,337	5,277	2,470	964	3,630	461	1,724
	25–29	173	1,301	3,411	2,390	1,621	1,139	2,432	1,663	1,061	2,619	508	1,247
	30–34	516	638	3,695	2,532	1,755	1,207	778	723	1,251	1,770	599	845
	35–39	0	0	4,007	2,891	1,901	1,376	0	0	1,474	981	705	470
	40–44	0	0	3,569	2,089	1,696	997	0	0	2,506	1,935	595	319
	45–49	0	0	4,041	2,396	1,434	855	0	0	3,506	1,903	414	181
	50–54	0	0	5,040	3,463	1,184	504	0	0	3,733	1,789	220	128
	55–59	0	0	4,487	6,368	527	404	0	0	2,756	3,032	163	108
	60–64	0	0	2,153	6,226	256	305	0	0	2,859	7,788	84	70
	65–69	0	0	2,252	3,685	134	195	0	0	4,057	10,198	60	46
	70–74	0	0	2,673	3,020	79	125	0	0	5,292	14,584	39	32
	75–79	0	0	2,673	3,020	79	125	0	0	5,292	14,584	39	32
6–10	10–14	3,654	2,986	2,063	2,210	985	1,054	3,654	2,986	2,063	2,210	985	1,054
	15–19	4,816	4,256	7,804	14,719	3,660	6,766	9,496	10,212	3,177	9,730	1,511	4,537
	20–24	978	1,993	4,476	3,470	2,120	1,649	3,359	2,024	1,323	3,327	633	1,582
	25–29	320	967	4,047	3,044	1,920	1,448	1,179	1,197	1,238	2,250	592	1,073
	30–34	461	477	4,158	3,100	1,972	1,475	760	380	1,640	1,462	784	699
	35–39	0	0	4,044	3,056	1,919	1,454	0	0	1,954	937	933	449
	40–44	0	0	3,146	2,798	1,496	1,201	0	0	2,219	1,468	791	354
	45–49	0	0	3,751	3,440	1,333	1,059	0	0	2,907	1,588	684	189
	50–54	0	0	4,358	4,121	1,027	786	0	0	3,276	1,900	430	113
	55–59	0	0	3,865	5,097	455	495	0	0	2,947	2,848	316	84
	60–64	0	0	2,627	4,689	311	462	0	0	2,853	4,239	153	62
	65–69	0	0	2,680	3,966	159	364	0	0	3,824	4,840	101	35
	70–74	0	0	3,144	4,767	93	205	0	0	4,687	5,286	61	22
	75–79	0	0	3,144	4,767	93	205	0	0	4,687	5,286	61	22
11+	10–14	2,883	2,072	1,840	3,593	879	1,706	2,883	2,072	1,840	3,593	879	1,706
	15–19	4,438	3,679	14,553	12,981	6,681	5,999	6,837	11,864	1,340	17,133	640	7,807
	20–24	374	1,186	5,489	3,933	2,593	1,865	1,323	1,495	1,532	2,845	732	1,355
	25–29	463	573	5,296	3,823	2,503	1,815	1,852	678	2,093	1,715	998	819
	30–34	409	283	5,029	3,931	2,379	1,866	1,718	190	2,458	1,141	1,171	546
	35–39	0	0	4,385	3,091	2,078	1,470	0	0	2,727	874	1,299	419
	40–44	0	0	2,750	3,681	1,309	1,146	0	0	1,856	1,166	886	301
	45–49	0	0	3,376	5,215	1,085	694	0	0	2,293	1,958	819	233
	50–54	0	0	3,432	4,989	703	499	0	0	3,219	2,218	646	132
	55–59	0	0	3,139	4,394	318	436	0	0	3,077	2,882	305	85
	60–64	0	0	2,893	3,412	278	340	0	0	3,259	2,316	160	69
	65–69	0	0	3,015	4,064	142	203	0	0	3,821	2,463	94	36
	70–74	0	0	3,571	7,872	83	148	0	0	4,223	2,245	52	33
	75–79	0	0	3,571	7,872	79	125	0	0	4,223	2,245	39	32

YLS (thousands) by age 75 by SEG over follow-up in Germany in the Alternative Scenarios_

SEG	Sc	Scenario	Men					Women

			LC	IHD	Stroke	COPD	All four diseases	LC	IHD	Stroke	COPD	All four diseases
A	1	Complete cessation	194	563	87	36	880	116	114	55	19	305
	3	Complete switch to RRPs (50% HnBs, 50% ECigs)	153	457	74	30	714	92	94	47	16	250
	6	Conversion Scenario	55	183	31	12	281	30	34	18	62	88
	7	Full Conversion Scenario	59	198	33	13	303	33	38	19	66	97
B	1	Complete cessation	312	855	142	66	1,374	175	175	77	37	465
	3	Complete switch to RRPs (50% HnBs, 50% ECigs)	247	689	119	56	1,112	138	143	65	32	378
	6	Conversion Scenario	92	277	51	24	444	48	55	26	13	143
	7	Full Conversion Scenario	96	290	53	25	464	51	58	28	14	151

Estimated Public Health Gains From Smokers in Germany Switching to Reduced-Risk Alternatives: Results From Population Health Impact Modelling by Socioeconomic Group

Figures & Tables

Figure 1

Figure 2

Figure 3

Figure 4

Drop in deaths by SEG over the follow-up period in Germany in the Alternative Scenarios_

Distribution of quit time a by SEG in Germany in 1995_

Annual probabilities of transition between SEGs by sex and age_

Data on population, proportion by SEG and smoking prevalence in Germany in 1995_a

Monthly tobacco transition probabilities (per million) by SEG in the Null Scenario for Germany_

YLS (thousands) by age 75 by SEG over follow-up in Germany in the Alternative Scenarios_

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