Tobacco endgame intervention impacts on health gains and Mā ori:non-Mā ori health inequity: A simulation study of the Aotearoa/New Zealand Tobacco Action Plan

Background The Aotearoa/New Zealand Government is aiming to end the tobacco epidemic and markedly reduce Mā ori:non-Mā ori health inequalities by legislating: (1) denicotinisation of retail tobacco, (2) 95% reduction in retail outlets and (c) a tobacco free-generation whereby people born after 2005 are unable to legally purchase tobacco. This paper estimates future smoking prevalence, mortality inequality and health-adjusted life year (HALY) impacts of these strategies. Methods We used a Markov model to estimate future yearly smoking and vaping prevalence, linked to a proportional multistate life table model to estimate future mortality and HALYs. Results The combined package of strategies (plus media promotion) reduced adult smoking prevalence from 31.8% in 2022 to 7.3% in 2025 for Mā ori, and 11.8% to 2.7% for non-Mā ori. The 5% smoking prevalence target was forecast to be achieved in 2026 and 2027 for Mā ori males and females, respectively. The HALY gains for the combined package over the population's remaining lifespan were estimated to be 594 000 (95% uncertainty interval (UI): 443 000 to 738 000; 3% discount rate). Denicotinisation alone achieved 97% of these HALYs, the retail strategy 19% and tobacco-free generation 12%. By 2040, the combined package was forcat to reduce the gap in Mā ori:non-Mā ori all-cause mortality rates for people 45+ years old by 22.9% (95% UI: 19.9% to 26.2%) for females and 9.6% (8.4% to 11.0%) for males. Conclusion A tobacco endgame strategy, especially denicotinisation, could deliver large health benefits and dramatically reduce health inequities between Mā ori and non-Mā ori in Aotearoa/New Zealand.