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

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

a Sources used: see text. Data on the distribution by SEG were for 2002 but taken to apply to 1995.

b Populations are given in hundreds. SEG: socioeconomic group defined based on education and income, with group A having the higher, and B the lower socioeconomic status. In the absence of available data, those aged 10–14 and 15–19 years were assumed to be equally divided between the two groups.

Table 2

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
Sex	Age (years)	<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

a Sources used: see text. Data on the distribution by SEG were for 2002 but are taken to apply to 1995.

b The full data separate 1–2 years into 1 and 2 years, 11–20 years into 11–15 and 16–20 years, and 21+ years into 21–30, 31–40, and 41–50 years. SEG: socioeconomic group defined based on education and income, with group A having the higher, and B the lower socioeconomic status.

Table 3

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)
Period (years)	Age (years)	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

[i] The first period (1–5) relates to the 5 years starting in 1995, the second period (6–10) to the 5 years starting in 2000, and the third period (11+) to the 10 years starting in 2005.

[ii] The monthly probabilities of transition (per million) among the three states N = never, C = current, and F = former, are described by P (probabilities) followed by two subscripts, the first representing the state changed from and the second the state changed to.

[iii] Note that RRPs are not introduced in the Null Scenario.

[iv] SEG: socioeconomic group defined based on education and income, with group A having the higher and B the lower socioeconomic status. Note that yearly TPs can be derived from monthly TPs, given the assumption that only one transition may occur in one year, using the formula P (1 year) = 1 – (1 – P (1 month))¹².

Table 4

Annual probabilities of transition between SEGs by sex and age.

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

[i] SEG: socioeconomic group defined based on education and income, with group A having the higher and B the lower socioeconomic status.

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

Nicotine usage in the Conversion Scenario.

Table 5

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

SEG	Sc	Sex/Scenario	DD (n)					DD (%)
SEG	Sc	Sex/Scenario	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
A	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
B	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
A+B	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
A	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
B	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
A+B	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

[i] COPD: chronic obstructive pulmonary disease; DD: Drop in deaths; ECig: e-cigarette; HnB: heat-not-burn; IHD: ischaemic heart disease; LC: lung cancer; Sc: Scenario code; SEG: socioeconomic group defined based on education and income, with group A having the higher and B the lower socioeconomic status.

[ii] The total number of smoking attributable deaths in the null scenario for LC, IHD, Stroke, COPD and all four diseases were, respectively, 105,798 57,119 10,838 23,076 and 196,830 for men in group A, 252,847 127,700 23,143 60,908 and 464,597 for men in group B, 28,333 10,547 5,041 6,318 and 50,239 for women in group A and 77,367 28,795 10,281 20,829 and 137,272 for women in group B.

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

Table 6

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

SEG	Sc	Scenario	Men					Women
SEG	Sc	Scenario	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
A	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
B	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

[i] COPD: chronic obstructive pulmonary disease; ECig: e-cigarette; HnB = heat-not-burn; IHD: ischaemic heart disease; LC: lung cancer; Sc: Scenario code; SEG: socioeconomic group defined based on education and income, with group A having the higher, and B the lower socioeconomic status.

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

Articles in this issue

DOI: https://doi.org/10.2478/cttr-2022-0005 | Journal eISSN: 2719-9509 (formerly 1612-9237)

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Language: English, French, German

Page range: 52 - 67

Submitted on: May 27, 2021

Accepted on: Mar 1, 2022

Published on: May 5, 2022

Published by: Beiträge zur Tabakforschung GmbH

In partnership with: Paradigm Publishing Services

Keywords:

Smoking,

public health,

smoking-related disease,

modelling,

respiratory disease,

cardiovascular disease,

e-cigarettes,

heat-not-burn products,

Related subjects:

© 2022 Romana Rytsar, Smilja Djurdjevic, Alexander K. Nussbaum, Ashok Kaul, Emanuel Bennewitz, Peter N. Lee, John S. Fry, published by Beiträge zur Tabakforschung GmbH
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License.

Volume 31 (2022): Issue 1 (March 2022)

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

Figures & Tables

Table 1

Table 2

Table 3

Table 4

Figure 1

Figure 2

Table 5

Figure 3

Table 6

Figure 4

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