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International audience; The study aimed to explore the prospective associations between psychosocial factors at work from the job strain model and preventable mortality, including smoking- and alcohol-related mortality as well as external causes of death. The study was based on prospective data and relied on a sample of 1,511,456 individuals for which data on job history, mortality and causes of death were linked over the 1976–2002 period. Exposures were the factors from the job strain model imputed through a job-exposure matrix. Various time-varying measures of exposure were used including current exposure and two measures of cumulative exposure. Preventable mortality was defined using the OECD/Eurostat list of preventable causes of death. The associations between exposures and outcomes were studied using Cox proportional hazards models. Effect modification by gender was also assessed. Over the study period, 57,264 preventable deaths occurred before the age of 75 years. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with preventable mortality, and associations of stronger magnitude were found for job strain and isostrain among men. Stronger associations were observed for alcohol-related mortality than for smoking-related mortality and external causes of death. The fractions of preventable mortality attributable to current exposure to job strain and isostrain were significant among men only (5.1% and 3.3%). Psychosocial factors at work from the job strain model may play a role on preventable mortality. Intensifying research and prevention towards the psychosocial work environment may be helpful to reduce risky health-related behaviours and related mortality.

Ivan P Artyukhov,1 Irina L Arshukova,2 Elena A Dobretsova,2 Andrey V Shulmin2 1Department of Health Care Management, 2Department of Public Health and Health Care, Krasnoyarsk State Medical University, Krasnoyarsk, Russia Background: This study assesses mortality and economic burden due to the regular tobacco usage among the population of the Krasnoyarsk region of the Russian Federation. This territory was chosen for the analysis because of two factors: high smoking prevalence in the Krasnoyarsk region (46% among the adult population) and premature mortality of the working-age population, which leads to a significant burden to the federal budget of the Russian Federation. Data sources: In our work, three main causes of smoking-related deaths were considered: cardiovascular disease, lung cancer, and COPD. The working-age population was investigated (20–72years old). The databases of mortality and population size of the territorial body of state statistics of the Krasnoyarsk region (data for 2013) were used as the information sources. Methods: Joint application of population-attributable risk and disability-adjusted life years method allowed us to estimate medico-demographic and economic burden due to the tobacco-attributable premature mortality in the investigated population. Results: We found that tobacco use-related economic burden is at least equal to 2% of the gross regional product of the Krasnoyarsk region in 2013. Conclusion: An assessment of economic tobacco use-related burden is important for determining the volume of necessary funding for development of smoking prevention programs, proper estimation of tobacco companies’ taxation, and other measures for controlling tobacco use. Smoking cessation is a priority for prevention of the tobacco-related diseases and reduction of their burden on local economy. Keywords: lung cancer, COPD, cardiovascular disease, disability-adjusted life years, population-attributable risk, smoking-related mortality&nbsp

Christine L Baker,1 Guilhem Pietri2 1Pfizer Inc., New York, NY, USA; 2Data Pyxis Ltd., St Albans, UK Background: The cost-effectiveness of varenicline has been demonstrated in the US health care setting using the Benefits of Smoking Cessation on Outcomes (BENESCO) model to simulate the lifetime direct costs and consequences of a hypothetical cohort of US adult smokers who make a single attempt to quit. The aim of this study was to undertake an updated cost-effectiveness analysis, using current epidemiology inputs and recently published smoking cessation data from the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES), the largest clinical trial of smoking cessation pharmacotherapies conducted to date.Methods: BENESCO is a Markov model simulating the effect of a single attempt to quit smoking on four smoking-related diseases: coronary heart disease, stroke, chronic obstructive lung disease, and lung cancer. Inputs were updated to include efficacy from EAGLES and newer data for the epidemiology of smoking in the US, the epidemiology and direct treatment costs of the four morbidities, and the costs of the interventions. Analyses compared varenicline, bupropion, nicotine replacement therapy (NRT) patch, and placebo with regard to the incidence of smoking-related morbidity, the incidence of smoking-related mortality, and cost-effectiveness at a time horizon from 2years to lifetime.Results: The study cohort comprised of 18,394,068 US adult smokers who made a single quit attempt during the first year of the model. For varenicline, there were an estimated 319,730 fewer smoking-related morbidities at the lifetime compared with placebo. Similarly, smoking-related mortality decreased by 198,240 subjects when varenicline was compared with placebo. For the same time horizon, varenicline was more effective and less costly, ie, dominant, compared with all comparators in the cost-effectiveness analysis.Conclusion: Based on the BENESCO model, smoking cessation with varenicline results in reduced incidence of smoking-related morbidity and mortality compared with other smoking cessation interventions and remains a cost-effective strategy in the US population. Keywords: cost-effectiveness, smoking cessation, varenicline, BENESCO model, EAGLES trial, smoking-related morbidity, smoking-related mortality

Background This study assesses mortality and economic burden due to the regular tobacco usage among the population of the Krasnoyarsk region of the Russian Federation. This territory was chosen for the analysis because of two factors: high smoking prevalence in the Krasnoyarsk region (46% among the adult population) and premature mortality of the working-age population, which leads to a significant burden to the federal budget of the Russian Federation. Data sources In our work, three main causes of smoking-related deaths were considered: cardiovascular disease, lung cancer, and COPD. The working-age population was investigated (20–72 years old). The databases of mortality and population size of the territorial body of state statistics of the Krasnoyarsk region (data for 2013) were used as the information sources. Methods Joint application of population-attributable risk and disability-adjusted life years method allowed us to estimate medico-demographic and economic burden due to the tobacco-attributable premature mortality in the investigated population. Results We found that tobacco use-related economic burden is at least equal to 2% of the gross regional product of the Krasnoyarsk region in 2013. Conclusion An assessment of economic tobacco use-related burden is important for determining the volume of necessary funding for development of smoking prevention programs, proper estimation of tobacco companies’ taxation, and other measures for controlling tobacco use. Smoking cessation is a priority for prevention of the tobacco-related diseases and reduction of their burden on local economy., Video abstract

PURPOSE: We examined the role of smoking in the two dimensions behind the time trends in adult mortality in European countries, that is, rectangularization of the survival curve (mortality compression) and longevity extension (increase in the age-at-death).METHODS: Using data on national sex-specific populations aged 50 years and older from Denmark, Finland, France, West Germany, Italy, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom, we studied trends in life expectancy, rectangularity, and longevity from 1950 to 2009 for both all-cause and nonsmoking-related mortality and correlated them with trends in lifetime smoking prevalence.RESULTS: For all-cause mortality, rectangularization accelerated around 1980 among men in all the countries studied, and more recently among women in Denmark and the United Kingdom. Trends in lifetime smoking prevalence correlated negatively with both rectangularization and longevity extension, but more negatively with rectangularization. For nonsmoking-related mortality, rectangularization among men did not accelerate around 1980. Among women, the differences between all-cause mortality and nonsmoking-related mortality were small, but larger for rectangularization than for longevity extension. Rectangularization contributed less to the increase in life expectancy than longevity extension, especially for nonsmoking-related mortality among men.CONCLUSIONS: Smoking affects rectangularization more than longevity extension, both among men and women.

This article has been made available through the Brunel Open Access Publishing Fund. Background: Consistent evidence has demonstrated that smoking ban policies save lives, but impacts on health inequalities are uncertain as few studies have assessed post-ban effects by socioeconomic status (SES) and findings have been inconsistent. The aim of this study was to assess the effects of the national Irish smoking ban on ischemic heart disease (IHD), stroke, and chronic obstructive pulmonary disease (COPD) mortality by discrete and composite SES indicators to determine impacts on inequalities. Methods: Census data were used to assign frequencies of structural and material SES indicators to 34 local authorities across Ireland with a 2000–2010 study period. Discrete indicators were jointly analysed through principal component analysis to generate a composite index, with sensitivity analyses conducted by varying the included indicators. Poisson regression with interrupted time-series analysis was conducted to examine monthly age and gender-standardised mortality rates in the Irish population, ages ≥35 years, stratified by tertiles of SES indicators. All models were adjusted for time trend, season, influenza, and smoking prevalence. Results: Post-ban mortality reductions by structural SES indicators were concentrated in the most deprived tertile for all causes of death, while reductions by material SES indicators were more equitable across SES tertiles. The composite indices mirrored the results of the discrete indicators, demonstrating that post-ban mortality decreases were either greater or similar in the most deprived when compared to the least deprived for all causes of death. Conclusions: Overall findings indicated that the national Irish smoking ban reduced inequalities in smoking-related mortality. Due to the higher rates of smoking-related mortality in the most deprived group, even equitable reductions across SES tertiles resulted in decreases in inequalities. The choice of SES indicator was influential in the measurement of effects, underscoring that a differentiated analytical approach aided in understanding the complexities in which structural and material factors influence mortality.

Background Women now outlive men throughout the globe, a mortality advantage that is very established in developed European countries. Debate continues about the causes of the gender gap, although smoking is known to have been a major contributor to the difference in the past. Objectives To compare the magnitude of the gender gap in all-cause mortality in 30 European countries and assess the contribution of smoking-related and alcohol-related deaths. Methods Data on all-cause mortality, smoking-related mortality and alcohol-related mortality for 30 European countries were extracted from the World Health Organization Health for All database for the year closest to 2005. Rates were standardised by the direct method using the European population standard and were for all age groups. The proportion of the gender gap in all-cause mortality attributable to smoking-related and alcohol-related deaths was then calculated. Results There was considerable variation in the magnitude of the male ‘excess’ of all-cause mortality across Europe, ranging from 188 per 100 000 per year in Iceland to 942 per 100 000 per year in Ukraine. Smoking-related deaths accounted for around 40% to 60% of the gender gap, while alcohol-related mortality typically accounted for 20% to 30% of the gender gap in Eastern Europe and 10% to 20% elsewhere in Europe. Conclusions Smoking continues to be the most important cause of gender differences in mortality across Europe, but its importance as an explanation for this difference is often overshadowed by presumptions about other explanations. Changes in smoking patterns by gender suggest that the gender gap in mortality will diminish in the coming decades.