Importance Raising the price of cigarettes by increasing taxation has been associated with improved perinatal and child health outcomes. Transnational tobacco companies have sought to undermine tobacco tax policy by adopting pricing strategies that maintain the availability of budget cigarettes. Objective To assess associations between median cigarette prices, cigarette price differentials, and infant mortality across the European Union. Design, Setting, and Participants A longitudinal, ecological study was conducted from January 1, 2004, to December 31, 2014, of infant populations in 23 countries (comprising 276 subnational regions) within the European Union. Interventions Median cigarette prices and the differential between these and minimum cigarette prices were obtained from Euromonitor International. Pricing differentials were calculated as the proportions (%) obtained by dividing the difference between median and minimum cigarette price by median price. Prices were adjusted for inflation. Main Outcomes and Measures Annual infant mortality rates. Associations were assessed using linear fixed-effect panel regression models adjusted for smoke-free policies, gross domestic product, unemployment rate, education, maternal age, and underlining temporal trends. Results Among the 53 704 641 live births during the study period, an increase of &OV0556;1 (US $1.18) per pack in the median cigarette price was associated with a decline of 0.23 deaths per 1000 live births in the same year (95% CI, –0.37 to –0.09) and a decline of 0.16 deaths per 1000 live births the following year (95% CI, –0.30 to –0.03). An increase of 10% in the price differential between median-priced and minimum-priced cigarettes was associated with an increase of 0.07 deaths per 1000 live births (95% CI, 0.01-0.13) the following year. Cigarette price increases across 23 European countries between 2004 and 2014 were associated with 9208 (95% CI, 8601-9814) fewer infant deaths; 3195 (95% CI, 3017-3372) infant deaths could have been avoided had there been no cost differential between the median-priced and minimum-priced cigarettes during this period. Conclusions and Relevance Higher cigarette prices were associated with reduced infant mortality, while increased cigarette price differentials were associated with higher infant mortality in the European Union. Combined with other evidence, this research suggests that legislators should implement tobacco tax and price control measures that eliminate budget cigarettes.

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23 个欧盟国家的香烟价格差异与婴儿死亡率的关联

重要性 通过增加税收来提高卷烟价格与改善围产期和儿童健康结果有关。跨国烟草公司试图通过采用维持廉价卷烟供应的定价策略来破坏烟草税政策。目的 评估整个欧盟的卷烟价格中位数、卷烟价格差异和婴儿死亡率之间的关联。设计、设置和参与者 从 2004 年 1 月 1 日到 2014 年 12 月 31 日，对欧盟内 23 个国家（包括 276 个次国家地区）的婴儿群体进行了纵向生态研究。干预 卷烟价格中位数以及这些价格与最低卷烟价格之间的差异来自 Euromonitor International。定价差异计算为通过将中值和最低卷烟价格之间的差异除以中值价格获得的比例 (%)。价格根据通货膨胀进行了调整。主要成果和措施 年婴儿死亡率。使用针对无烟政策、国内生产总值、失业率、教育、孕产妇年龄和强调时间趋势进行调整的线性固定效应面板回归模型评估关联。结果 在研究期间的 53 704 641 名活产婴儿中，每包卷烟价格中位数增加 &OV0556;1（1.18 美元）与同年每 1000 名活产婴儿死亡人数减少 0.23 人相关（95% CI , –0.37 至 –0.09)，第二年每 1000 名活产婴儿死亡人数下降 0.16 (95% CI, –0.30 至 –0.03)。中间价卷烟和最低价卷烟之间的价格差异增加 10% 与次年每 1000 名活产婴儿死亡人数增加 0.07 人有关（95% CI，0.01-0.13）。2004 年至 2014 年间，23 个欧洲国家的卷烟价格上涨与 9208 (95% CI，8601-9814) 婴儿死亡人数减少有关；3195 (95% CI, 3017-3372) 如果在此期间中价卷烟和最低价卷烟之间没有成本差异，婴儿死亡是可以避免的。结论和相关性 较高的卷烟价格与降低的婴儿死亡率相关，而增加的卷烟价格差异与较高的欧盟婴儿死亡率相关。结合其他证据，