Simulation modeling of US tobacco control policies projected that continuing current policies decreases COPD prevalence by 18% by 2040, while eliminating smoking averts 140,000 COPD-related deaths.
Do tobacco control policies reduce projected COPD prevalence and mortality in U.S. ever smokers aged ≥30 years?
Simulation modeling demonstrates that continuing or strengthening tobacco control policies in the U.S. will avert millions of COPD cases and deaths by 2040.
Abstract Rationale Cigarette use is the leading preventable risk factor for COPD, responsible for approximately 80% of COPD deaths in the U.S. While tobacco control policies have reduced smoking prevalence, their long-term impact on COPD remains poorly quantified. Simulation modeling provides a tool for integrating epidemiological and policy data to project future disease burden. We applied the COPD Natural History Model (COPD-NHM) to assess how changes in smoking driven by tobacco control policies influence future COPD and PRISm burden among ever cigarette users. Methods We developed the COPD-NHM, a discrete-event microsimulation model that simulates individual life histories of U.S. ever smokers aged ≥30 years. The simulation model incorporates annual transitions between GOLD 0, Preserved Ratio Impaired Spirometry (PRISm) and GOLD 1, GOLD 2 and GOLD 3-4 based on age (39-54, 55-64, 65-90 years), sex (male, female), and smoking status (current or former). Using US-specific demographic and smoking trends, the model projects COPD and PRISm prevalence and cigarette-attributable COPD mortality from 2025 to 2040 under three policy scenarios: (1) StatusQuo, reflecting continuation of current tobacco control policies; (2) No-Regulation, modeling the absence of tobacco control policies; and (3) No-Smoking, where all cigarette initiation and cessation abruptly end in 2025. Primary outcomes include projected COPD (overall and by GOLD severity level) and PRISm prevalence among ever smokers and cumulative COPD-related deaths. Results Under the StatusQuo scenario, COPD prevalence decreases by 18%, from 16.8 million (10.7%) in 2025 to 13.9 million (7.8%) in 2040, while PRISm decreases from 8 million (5.0%) to 6.3 million (3.5%). GOLD 2 shows the largest reduction (1.4 million fewer cases). In contrast, in the No-Regulation scenario, COPD and PRISm prevalence increases by 100% among adults aged 30-49 years, but declines by ∼≤ 30% for all severity levels among adults ≥70 years compared with StatusQuo. This scenario results in approximately 1.9 million more deaths from PRISm and 5 million from COPD between 2025 and 2040. The No-Smoking scenario yields the greatest benefits. Among adults aged 30-49 years, PRISm and COPD prevalence across all GOLD levels decrease by ≥ 30%. GOLD 3-4 cases decline substantially in those aged 30-69 years. From 2025 to 2040, approximately 144,000 PRISm-related and 140,000 COPD-related deaths are averted. Conclusions Tobacco control policies substantially reduce future COPD burden. Eliminating smoking could avert thousands of severe COPD cases and deaths, particularly among younger adults. Strengthening tobacco control continues to be a critical component to control COPD in the coming decades. This abstract is funded by: NIH-National Cancer Institute
Romero et al. (Fri,) conducted a other in COPD and PRISm. Tobacco control policies (StatusQuo, No-Smoking) vs. No-Regulation was evaluated on Projected COPD and PRISm prevalence among ever smokers and cumulative COPD-related deaths. Simulation modeling of US tobacco control policies projected that continuing current policies decreases COPD prevalence by 18% by 2040, while eliminating smoking averts 140,000 COPD-related deaths.