Associations of cigarette price differentials with infant mortality in 23 European countries

Background Increasing cigarette prices has been associated with improved perinatal and child health outcomes. Transnational tobacco companies have adopted pricing strategies which maintain the availability of cheap cigarettes. We aimed to assess associations between median cigarette prices, cigarette price differentials and infant mortality in Europe. Methods We conducted a longitudinal ecological study of 276 regions in 23 European countries from 2004 to 2014. We obtained median cigarette prices and the differential between these and minimum cigarette prices from Euromonitor International. We calculated pricing differentials between minimum and median cigarette price as proportions of the median price. Prices were adjusted for inflation. Associations of median prices and price differentials with annual infant mortality rates were assessed using linear fixed-effect panel regression models adjusted for smoke-free policies; Gross Domestic Product; unemployment rate; education; maternal age; and underlining temporal trends. The analysis was conducted at a regional level. Results A €1 per pack increase in the median cigarette price was associated with a decline of -0.23 infant deaths per 1,000 live births in the same year (95% Confidence Interval [CI]: -0.37 to -0.09) and -0.16 per 1,000 live births the following year (95% CI: -0.30 to -0.03). An increase of 10% in the price differential between median and minimum priced cigarettes was associated with an increase of 0.07 infant deaths per 1,000 live births (95% CI: 0.01 to 0.13) the following year. Cigarette price increases across 23 European countries between 2004 and 2014 were associated with 9,208 (95% CI: 8,601 to 9,814) fewer infant deaths; an estimated 3,195 (95% CI: 3,017 to 3,372) infant deaths could have been avoided had there been no differential between median and the minimum priced cigarettes during this period. Conclusions Combined with other evidence this research suggests that legislators should implement tobacco tax and price control measures which eliminate budget cigarettes