Effects of tobacco control policy on cardiovascular morbidity and mortality in Russia

Abstract

Background According to the Global Adult Tobacco Survey carried out in Russia in 2009, the country had one of the highest smoking prevalence rates in Europe. In response to this health and economic burden, Russia implemented a comprehensive Tobacco Control Law (TCL) in 2013, which has been associated with a 21.5% relative decline in adult smoking prevalence in 2016 compared with 2009. This study tests the impact of the TCL on cardiovascular disease (CVD) related health outcomes, including morbidity and mortality. Method The study evaluated the TCL as an intervention in a natural experiment during the period 2003–2015. A synthetic control was created as a comparator, using data from countries that did not have a comparable comprehensive tobacco control intervention. Changes in trends in CVD outcomes – hospital discharge rates (HDRs) and standardized death rates (SDRs) – were then compared to test for an impact associated with the TCL. Results Pre-intervention trends in CVD-related HDRs were similar between Russia and the synthetic control, but became divergent after the TCL with greater benefit observed in Russia. This implies a beneficial impact of the TCL on CVD related morbidity in the Russian population. Whilst SDRs continued to reduce in both Russia and the control, the impact of TCL is less clear. Conclusion This study provides further evidence to support comprehensive tobacco control in line with the WHO Framework Convention for Tobacco Control (WHO FCTC). Alongside a reduction in tobacco consumption, smoking-related CVD morbidity appears to benefit quite soon after implementation, whilst smoking-related deaths might need a longer post-intervention period to be detectable.

Mortality in Russia Since the Fall of the Soviet Union

“…This law banned smoking in all public places, banned all types of tobacco advertising and sponsorships, and required pictorial warnings on cigarette packages (Quirmbach and Gerry 2016). These regulations are well-enforced across the Russian Federation (Gambaryan et al 2018). In conjunction with these regulations, rising excise taxes led the real price of a pack cigarettes to nearly triple between 2008 and 2017, from 11.06 rb/pack (2002 rb) to 30.90 rb, although cigarette prices remain low in comparison with other countries (Zheng et al 2018).…”

“…The risk of cardiovascular mortality (particularly deaths due to vascular diseases, such as ischemic heart disease (Lopez et al 1994)) declines rapidly after smoking cessation, and the difference in cardiovascular mortality risk between smokers and non-smokers goes to zero within 10 years of quitting (Shkolnikov et al 2020). There is already some evidence of the impact of the Tobacco Control Law on the incidence of cardiovascular disease: Gambaryan et al (2018) use synthetic control methods to demonstrate that hospital discharge rates for cardiovascular disease declined in Russia relative to a synthetic control country after the Tobacco Control Law was implemented. Shkolnikov et al (2020) estimate that 48,000 male cardiovascular deaths were avoided in 2008-2016 due to the decrease in male smoking rates, which is about 6.2% of all male deaths in that period.…”

Going beyond health efficiency: What really matters?

“…Public‐private partnerships for healthy eating could better regulate obesity: basic guidelines for building a framework can be found in De Pinho Campos et al This could significantly affect a country's overall health and reduce the inefficiency of the healthcare system. The WHO should also consider the results of this analysis and introduce a framework convention on obesity control: the Framework Convention on Tobacco Control, introduced in 2005, has already had positive results …”

Google Trends on Obesity, Smoking and Alcoholism: Global and Country-Specific Interest

“…Analyzing the term “smoking”, we could not see a wide variation of interest during the period of the study, but a small peak in RSVs was recorded at the beginning of 2013. This peak could be due to the anti-smoking policies that were implemented that year in Russia [ 31 ], Chile, and Uruguay [ 32 ]. Several authors stated that in countries where anti-smoking control policies were implemented, smoking prevalence decreased [ 33 , 34 , 35 ].…”