Association between cigarette tax and the global burden of non-communicable diseases: a longitudinal ecological study in 193 countries (2026)

Background: Tobacco control has been a critical strategy to reduce non-communicable disease (NCD) burden. However, the association between cigarette taxes and NCD burdens and its disparity by income level of countries, age group, sex and cause of NCDs has not been well-investigated.
Methods: This longitudinal ecological study analysed country-level data from 193 countries during 2008-2023, including cigarette taxes, NCD burdens and relevant covariates sourced from the WHO, Global Burden of Disease and World Bank. Fixed-effect panel regression models were used to assess the association incorporating a 2-year lagged exposure to account for the potential delayed effects of tax policies.
Results: Among the included countries, there were 26 (13%) low-income, 52 (27%) lower-middle-income, 53 (27%) upper-middle-income and 62 (32%) high-income countries, respectively. Overall, a 1-percentage-point increase in total tax (the proportion of the average retail price of a 20-pack of cigarettes) was significantly associated with a 16.43 (95% CI -21.63 to -11.24) and 0.63 (95% CI -0.83 to -0.42) reduction in disability-adjusted life years (DALYs) and deaths of NCD per 100?000 people, respectively. Greater associations were observed in high-income countries and upper-middle-income countries but no significant association for low-income countries. Compared with other types of taxes, increase in specific tax (tax charged per quantity) was associated with more reduction of NCD burden (DALY rate: -7.16, 95% CI -11.66 to -2.67). The impact of cigarette tax on NCD outcomes was greater among older adults and males compared with their counterparts. For cause-specific diseases, higher total tax was significantly associated with the greatest reduction in cardiovascular disease, followed by digestive disease and neoplasms.
Conclusions Higher cigarette tax was associated with lower NCD burdens, particularly in upper-middle-income and high-income countries, with specific excise taxes driving most benefits. Integrated action to increase total tax and optimise the tax structure tailored to countries is needed to accomplish the dual benefits of health and economy globally. [Author's abstract]