Abstract
INTRODUCTION: The temporal relationship between smoking exposure and bladder cancer (BC) diagnosis remains ill defined. This study aims to cross-correlate and temporally associate changes in US tobacco tax and consumption with BC incidence. METHODS: US tobacco consumption, tobacco tax data, and BC incidence rates from 1975 to 2019 were retrieved. A cross-correlation lag time for tobacco tax and consumption on BC incidence was calculated while controlling for national health expenditure. Proxied lag weighted semi-log linear models were used to determine the rate of change in BC incidence rates associated with a 1% change in tobacco tax percentages on a national and state level. RESULTS: A 1% increase in tobacco tax was associated with a 1.77% decrease in BC incidence over a 6-year period (R(2) = 0.9687, P = .00044). Twenty-two states had a statistically significant decline in BC incidences correlated with increasing tobacco taxation. Reduction in BC incidence > 0.5% was observed in states along the western and eastern US borders. Montana, Utah, Nebraska, Arkansas, and Tennessee did not have decreasing BC incidences from tobacco tax increases. California had the most drastic decline in BC incidence (1.98%). Nationally, tobacco consumption decrease in 1 pack per capita was associated with a 0.47% decrease in BC incidence over a 28-year period (R(2) = 0.984, P = .00011). CONCLUSIONS: Declining US tobacco consumption may indicate significant reduction in BC incidence through 2047. Primary prevention through adaptation of state-legislated tax changes may contribute to a reduction in BC incidence in states lying within the Central United States. A national tobacco tax initiative can be considered given the improvement in population health.