Estimating the long-run relationship between state cigarette taxes and county life expectancy

Abstract

Introduction: While a large body of literature suggests that tobacco control legislation-including fiscal measures such as excise taxes-effectively reduces tobacco smoking, the long-run (10+ years) relationship between cigarettes excise taxes and life expectancy has not been directly evaluated. Here, we test the hypothesis that increases in state cigarette excise taxes are positively associated with long-run increases in population-level life expectancy.

Methods: We studied age-standardised life expectancy among all US counties from 1996 to 2012 by sex, in relation to state cigarette excise tax rates by year, controlling for other demographic, socioeconomic and county-specific features. We used an error-correction model to assess the long-run relationship between taxes and life expectancy. We additionally examine whether the relationship between cigarette taxes and life expectancy was mediated by changes to county smoking prevalence and varied by the sex, income and rural/urban composition of a county.

Results: For every one-dollar increase in cigarette tax per pack (in 2016 dollars), county life expectancy increased by 1 year (95% CI 0.60 to 1.40 years) over the long run, with the first 6-month increase in life expectancy taking 10 years to materialise. The association was mediated by changes in smoking prevalence and the magnitude of the association steadily increased as county income decreased.

Conclusions: Results suggest that increasing cigarette excise tax rates translates to consequential population-level improvements in life expectancy, with larger effects in low-income counties.

Keywords: public policy; smoking caused disease; taxation.

Figure 1

Average and state-specific trends in state cigarette tax rates, 1996–2012. Inflation-adjusted (2016 dollars) changes in national average (orange) and state-specific cigarette taxes per pack of 20 during the study period.

Figure 2

Long-run association of cigarette taxes and county-level life expectancy. Long-run changes in life expectancy at the county level by subgroup from the main regression analysis with adjustment for county-year income per capita, share female, share black, share over 65, share under 18 and share with high school, and fixed effects for county. 95% CIs reflect Huber-White robust SEs clustered at the state level. Positive values represent increases in life expectancy. Cigarette tax dollars are inflation-adjusted to 2016 year dollars. Income Q1–5 correspond to quintiles of county income per capita. Vertical dashed line is overall average effect.

Figure 3

Long-run association of cigarette taxes and smoking prevalence. Long-run changes in smoking prevalence at the county level by subgroup from the main regression analysis with adjustment for county-year income per capita, share female, share black, share over 65, share under 18 and share with high school, and fixed effects for county. 95% CIs reflect Huber-White robust SEs clustered at the state level. Positive values represent increases in life expectancy. Cigarette tax dollars are inflation-adjusted to 2016 year dollars. Income Q1–5 correspond to quintiles of county income per capita. Vertical dashed line is overall average effect.