State Cigarette Taxes and Lung Cancer Incidence, United States, 1970-2019

Abstract

Objectives: Although smoking is the leading cause of lung cancer, smoking rates have been declining for decades, in part due to increasing cigarette taxes. This study analyzed how states increased and responded to cigarette taxes to determine whether increasing contemporary cigarette taxes could reduce lung cancer incidence in the United States.

Methods: Centers for Disease Control and Prevention data were used to measure state-level cigarette tax and consumption (pack sales per capita). For each state, the elasticity of demand (change in cigarette consumption percentage/change in state tax) was estimated. Then, each state was classified into 4 mutually exclusive groups based on median change in the state cigarette tax from 1970 to 2019 (high, low) and median elasticity (high, low). Finally, state-level, sex-stratified data from the North American Association of Centralized Cancer Registries (2000-2019) were analyzed to test whether the incidence of small cell and squamous cell lung cancer varied by group.

Results: From 1970 to 2019, cigarette tax increases ranged from $0.08 (Missouri) to $4.90 (District of Columbia). The median tax increase was $1.54. The elasticity of demand for cigarettes from state taxes ranged from -0.10 (West Virginia) to -0.64 (Georgia). The median elasticity was -0.40. Among males, the low-elasticity, low-tax change group had the highest incidence of small cell and squamous cell lung cancer. No significant differences in incidence were found across groups among females.

Conclusions: Increasing cigarette taxes could reduce the future incidence of lung cancer among males. Other social or environmental policies, however, may be necessary to reduce lung cancer incidence among females.

Keywords: cancer; economics; policy; prevention; smoking; tobacco.

Figure 1.

Cigarette consumption and state cigarette taxes, United States, 1970-2019. Each point in the figure represents the cigarette consumption (pack sales per capita) and corresponding cigarette tax rate for each state.

Figure 2.

Change in state cigarette tax rates, by state and elasticity group, United States, 1970-2019. The elasticity group indicates whether the state’s elasticity of demand for cigarette packs with respect to changes in tax rates is above (“high”) or below (“low”) the median elasticity.

Figure 3.

The elasticity of demand for cigarettes in state cigarette tax rates, by state and tax rate change group, United States, 1970-2019. The elasticity of demand for cigarette consumption (pack sales per capita) is shown with respect to changes in state cigarette tax rates. The tax rate change group indicates whether the state’s change in cigarette tax rate from 1970 to 2019 is above (“high”) or below (“low”) the median change in tax rates. Error bars indicate 95% CIs of the estimated elasticity. Elasticity was estimated via a log-transformed (log-log) linear regression model.

Figure 4.

Trends in age-adjusted incidence (per 100 000 population) of small cell and squamous cell lung cancer, by sex and state group, United States, 1970-2019. The tax rate change group indicates whether the state’s change in cigarette tax rate from 1970 to 2019 is above (“high”) or below (“low”) the median change in tax rates. The shaded region represents 95% CIs of the incidence rate. Abbreviations: E, elasticity; D, tax change.