Impact of tobacco smoking prevalence on cardiovascular and non-cardiovascular deaths in England and Wales, 2017–40: a modelling study

Smoking generates a huge burden of morbidity and mortality globally and in the UK. We aimed to estimate the impact of two smoking reduction scenarios on numbers of deaths to 2040 in England and Wales. We developed a probabilistic Markov model, IMPACT-BAM, to integrate calendar trends in the incidence of cardiovascular disease, dementia, disability, and mortality to forecast future prevalence of these conditions in addition to numbers of deaths from cardiovascular and non-cardiovascular causes in the population of England and Wales. We used data from the English Longitudinal Study of Ageing and Office for National Statistics to inform the model. Systematic reviews and meta-analyses provided relative risks of cardiovascular disease, dementia, disability, and mortality among smokers by age and sex. We estimated the future numbers of cardiovascular and non-cardiovascular conditions and deaths in the England and Wales population to 2040 (baseline forecast). We then quantified the potential benefits of two contrasting tobacco policies. If smoking prevalence remains at current levels of 19% in men (17% in women), between 2017 and 2040 there will be an estimated 950 000 deaths from cardiovascular causes (95% uncertainty interval [UI] 576 000–1 915 000) and about 10 770 000 deaths from non-cardiovascular causes (8 022 000–14 112 000) in the population aged 65 years and over. If smoking prevalence continues to decline by 0·7% per year (as observed over the past decade), by 2040 there will be an estimated 19 000 fewer deaths from cardiovascular causes (95% UI 3700–58 000) and 170 000 fewer deaths from non-cardiovascular causes (89 000–289 000). If smoking prevalence is reduced to 9% by 2020 and 5% by 2025, there will be 34 000 fewer deaths from cardiovascular disease (95% UI 8200–111 000) and 349 000 fewer deaths from non-cardiovascular causes (188 000–574 000). Public health programmes targeting tobacco smoking could potentially prevent over a third of a million cardiovascular and non-cardiovascular deaths by 2040. British Heart Foundation (grants RG/13/2/30098, RG/16/11/32334).