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Prospective impact of tobacco eradication and overweight and obesity eradication on future morbidity and health-adjusted life expectancy: simulation study
  1. Tony Blakely1,2,
  2. Cristine Cleghorn2,
  3. Frederieke Petrović-van der Deen2,
  4. Linda J Cobiac2,3,
  5. Anja Mizdrak2,
  6. Johan P Mackenbach4,
  7. Alistair Woodward5,
  8. Pieter van Baal6,
  9. Nick Wilson7
  1. 1 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Department of Public Health, University of Otago, Wellington, New Zealand
  3. 3 The British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
  4. 4 Public Health, Erasmus MC, Rotterdam, The Netherlands
  5. 5 School of Population Health, The University of Auckland, Auckland, New Zealand
  6. 6 Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
  7. 7 Public Health, University of Otago, Wellington, Wellington, New Zealand
  1. Correspondence to Dr Tony Blakely, Melbourne School of Population and Global Health, The University of Melbourne, Parkville VIC 3010, Australia; ablakely{at}


Background Interventions that reduce morbidity, in addition to mortality, warrant prioritisation. It is important to understand the magnitude of potential morbidity and health gains from changing risk factor distributions. We quantified the impact of tobacco compared with overweight/obesity eradication on future morbidity and health-adjusted life expectancy (HALE) for the New Zealand population alive in 2011.

Methods Business-as-usual (BAU) future smoking rates were set based on past falling rates, but we assumed no future change in Body Mass Index (BMI) distribution, given historic trends. Population impact fractions and the percentage reduction in incidence rates for 16 tobacco-related and 14 overweight/obesity-related diseases (allowing for time lags) were calculated using the difference between BAU and eradication risk factor scenarios combined with tobacco and BMI incidence rate ratios. We used two multistate lifetable models to estimate HALE changes over the remaining lifespan and morbidity rate changes 30 years hence.

Results HALE gains always exceeded life expectancy (LE) gains for overweight/obesity eradication (ie, absolute compression of morbidity), but for eradication of tobacco, the pattern was mixed. For example, among 32-year-olds in 2011, overweight/obesity eradication increased HALE by 2.06 years and LE by 1.21 years, compared with 0.54 and 0.50 years for tobacco eradication.

Morbidity rate reductions 30 years into the future were considerably greater for overweight/obesity eradication (eg, a 15.8% reduction for 72-year-olds in 2041, or the cohort that was aged 42 years in 2011) than for tobacco eradication (2.7%). The same rate of morbidity experienced at age 65 years under BAU was deferred by 5 years with overweight/obesity eradication.

Conclusions Preventive programmes that reduce overweight and obesity have strong potential to reduce or compress morbidity, improving the average health status of ageing populations. This paper simulated eradication of tobacco and overweight/obesity; actual interventions will have lesser health impacts, but the relativities of morbidity to mortality gains should be similar.

  • tobacco
  • obesity
  • epidemiology
  • health impact assessment
  • morbidity

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  • Contributors TB led the study conceptualisation, study design and write-up, and contributed to the analyses. All authors contributed to the interpretation and drafting of the paper. CC and AM undertook the analyses. FP-vdD and CC led the major development of the smoking and diet multistate lifetables, respectively.

  • Funding This project was principally funded by the Health Research Council of New Zealand Programme Grants for the Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3, 10/248 and 16/443).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. We use simulation models that source data from multiple sources. Much of the input data can be found in Technical Reports. If necessary, the authors can provide data upon request.