Background: Australia is one of several countries aiming to achieve a commercial tobacco endgame, with a current target of ≤5% daily smoking prevalence by 2030. Like other jurisdictions, the Australian target ignores large variations in smoking across sociodemographic groups and risks perpetuating current smoking-related inequities. To help mitigate this risk, we calculated future smoking rates under business-as-usual for multiple sociodemographic categories and compared them to the endgame target.
Methods: We used a simulated annealing optimization approach to estimate historic daily smoking rates in Australia by six dimensions of sex, age, remoteness, index of relative socioeconomic advantage and disadvantage, and Indigenous status, using multiple datasets from 2001 to 2022-23. We applied logistic regression to the modelled outputs to forecast cohort smoking rates for 30 years.
Results: At the population level, daily smoking is expected to reach 7.8% by 2030 under business-as-usual. Of the 15 strata combinations of remoteness and socioeconomic status in the model, only two met the ≤5% target by 2030, with smoking prevalence remaining highest (34.6% in 2030) for people living in the most disadvantaged (remote, SES1) areas.
Conclusions: Our modelling suggests that if equity is not at the forefront of Australian tobacco policy, ongoing smoking disparities are likely to continue even if the endgame goal is achieved. Our approach offers a crucial baseline for assessing the impact of tobacco control interventions by different sociodemographic dimensions and presents a methodological framework that could be adapted for analysing smoking-related inequities in other jurisdictions. This framework should also be extended, incorporating uncertainty into modelled estimates.
Background: Published studies rarely assess associations between trajectories of drinking and mortality.
Methods: We aimed to assess associations between long-term sex-specific drinking trajectories and all-cause and disease-specific mortality for 39 588 participants (23 527 women; 16 061 men) enrolled in the Melbourne Collaborative Cohort Study in 1990-94 aged 40-69 years. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause, cardiovascular disease- and cancer-specific mortality in relation to group-based alcohol intake trajectories.
Results: There were 7664 deaths (1117 cardiovascular; 2251 cancer) in women over 595 456 person-years, and 7132 deaths (1283 cardiovascular; 2340 cancer) in men over 377 314 person-years. We identified three distinct group-based alcohol intake trajectories for women: 'lifetime abstention', 'stable light', and 'increasing moderate'; and six for men: 'lifetime abstention', 'stable light', 'stable moderate', 'increasing heavy', 'early decreasing heavy', and 'late decreasing heavy'. We observed 9%-12% lower all-cause mortality, driven by associations with cardiovascular disease-specific deaths, for 'stable light' (women: HR 0.91; 95% CI 0.87-0.96; men: HR 0.88; 95% CI 0.82-0.94) and 'stable moderate' (HR 0.88; 95% CI 0.81-0.96) drinking, compared with 'lifetime abstention'. In contrast, all-cause mortality was 18%-21% higher for 'early decreasing heavy' (HR 1.18; 95% CI 1.05-1.32) and 'late decreasing heavy' (HR 1.21; 95% CI 1.04-1.40) drinking, and cancer-specific mortality 19%-37% higher for 'increasing moderate' (HR 1.19; 95% CI 1.00-1.43), 'early decreasing heavy' (HR 1.34; 95% CI 1.10-1.64), and 'late decreasing heavy' (HR 1.37; 95% CI 1.06-1.77) drinking.
Conclusions: Our findings highlight the importance of avoiding higher levels of alcohol intake during the life course to reduce all-cause and cancer-specific mortality.
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