Early Indicators of Health Effects of Heated Tobacco Products

According to a study conducted in Japan, symptoms of smoking-related diseases may take several decades to appear, while alternative tobacco products have been introduced relatively recently. Therefore, there is no long-term epidemiological research, but real data can be used to attempt to find early signs of the impact of heated tobacco products (HTP) on public health.

From Japan to a city pilot in 2014, HTPs were launched nationwide in 2016 with the introduction of Philip Morris International's tobacco heating system. While overall tobacco sales have not shown a continuous decline, HTPs have led to a rapid decrease in cigarette sales. Two studies conducted in Japan, "The impact of the introduction of IQOS on cigarette sales: Evidence of decline and substitution" and "Why have cigarette sales declined rapidly in Japan?", were published in the Tobacco Control and International Journal of Environmental Research and Public Health in 2019 and 2020, respectively. These studies show that cigarette sales began to decrease significantly after the introduction of IQOS heating non-combustible products in 11 regions of Japan. The introduction of electronic cigarettes was staggered by region, and better predicted the timing of the decline in cigarette sales than any single model applied to all regions at the same time, adjusting for the actual month of introduction of IQOS heating non-combustible products in each region.

Another study attempted to determine whether the introduction of high technology procedures (HTP) in Japan is related to hospitalization rates for chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) worsening, showing a significant reduction in hospitalization rates for COPD worsening in Japan, although IHD hospitalization rates showed a slight decrease but were not significant.

A more comprehensive study was published in the June 2022 issue of the Journal of Public Health using the Japan Medical Data Center (JMDC) insurance claims database to replicate prior research, which included cumulative receipts and diagnoses for approximately 7.3 million patients. The study population included adults, corporate employees, and their family members who were hospitalized between January 2010 and December 2019. Analysis was conducted on full data from 2010 to 2019 and shorter-term data from 2013 to 2019, but no significant differences were found between the two periods.

According to an analysis conducted using data from the JMDC, the hospitalization rates for smoking-related illnesses have changed since the introduction of heated tobacco products. Specifically, when all available database data is used, hospitalization rates for chronic obstructive pulmonary disease and ischemic heart disease have significantly decreased. However, hospitalization rates for chronic obstructive pulmonary disease did not decrease significantly due to worsening of the condition and accompanying lower respiratory tract infections.

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