E-cigarettes, vaping could save 6.6 million deaths in the USA

Researchers have finally quantified the number of deaths that have been averted by millions of smokers switching from traditional cigarettes to electronic cigarettes or e-cigarettes. The study titled “Potential deaths averted in USA by replacing cigarettes with e-cigarettes” was published in the latest issue of Tobacco Control.

Authors write that despite several attempts on the part of the government to curb smoking, the impact has been relatively slow. They attempted to look at the effects of switching from traditional cigarettes to e cigarettes among the population. This, they write would then be considered as an “effective strategy” to reduce the effects of tobacco on the population.

For this purpose a project was developed by applying a “Status Quo Scenario”. They looked at smoking rates and health outcomes when there are no e-cigarettes or vaping i.e. status quo maintained. This was then compared with a “Substitution model” meaning all health outcomes projected once cigarette use is replaced by e-cigarette use over a period of 10 years.

Image Credit: Hurricanehank / Shutterstock
Image Credit: Hurricanehank / Shutterstock

They ran two scenarios – an optimistic one and a pessimistic one. These differed in terms of relative harms caused by e-cigarettes and regular cigarettes. They looked at the effects of these two scenarios on several issues including initiation of smoking, cessation of smoking and also switching from one to another. In the optimistic scenario, 5 percent of the population still smoked and in the pessimistic scenario, 10 percent of the population still smoked.

In the study population, the ones who would replace cigarettes with e-cigarettes before they were 40 years of age, were treated as never smokers using e-cigarettes. This is because their risk of health damage due to smoking would be far less than conventional smokers. Those who replace cigarette with e-cigarette use after age 40 years would be treated in the study as former smokers who switched to e-cigarettes.

Finally they compared the two scenarios Status Quo and E-Cigarette Substitution between 2016 and 2100 using computational models. The health impact on the public was determined from these computational models. Smoking prevalence in 2016 is 19.3% for men and 14.1% for women at baseline.

Results showed that when compared to Status Quo, if E-cigarette substitution is adopted over a 10 year period –

  • In the Optimistic scenario - 6.6 million (4.8 million male; 1.7 million female)  less premature deaths and 86.7 million (62.9 million male; 23.9 million female) less life years lost. This means 25% fewer premature deaths and 35% fewer life years lost with the switch.
  • In the Pessimistic scenario - 1.6 million (1.4 million male; 0.3 million female) less premature deaths and 20.8 million (17.8 million male; 3.0 million female) fewer life years lost. This means 6% fewer premature deaths and 8% fewer life years lost with the switch.
  • Among those aged 15 years in 2016, the life expectancy gained is 0.5 years after a switch is made. The assessment was made for a projected age of 99 years for this population

Authors conclude that there have been debates regarding the benefits and harms caused by switching to e-cigarettes from regular smoking. This study shows definite benefits in shifting to this strategy. It would add life years and also reduce the risk of premature deaths even if all the negatives are considered in the pessimistic assumptions.

David Levy, who co-led the work at Georgetown University Medical Center in the United States said that the older policies of tobacco control could be modified after these findings to encourage “substituting e-cigarettes for the far deadlier cigarettes”.

He said that there would be “tremendous” health benefits with the switch which includes not only reduced disease in smokers but also a reduction in exposure to second hand smoke.

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