Abstract
INTRODUCTION: Nearly one in three adults in Germany smokes tobacco, with higher rates among those with lower educational attainment. This contributes to a disproportionate financial burden on low-income households, which spend a larger share of their income on tobacco. Rising prices may exacerbate this: the average price per cigarette rose from 30 cents in 2020 to 36 cents in 2024. However, not all cigarettes consumed in Germany are taxed, often due to cross-border purchases or illicit trade. Data on the extent of this issue remains limited. This paper examines (1) household expenditures on these products relative to income and (2) the consumption of untaxed cigarettes. METHODS: We analysed data from the German Study on Tobacco Use (DEBRA, Deutsche Befragung zum Rauchverhalten), a repeated cross-sectional, representative household survey (March-November 2024). A total of 10 584 people were interviewed, including 3462 adults using at least one nicotine or tobacco product. Expenditure was measured as self-reported weekly spending on all nicotine and tobacco products, including utensils, converted into monthly expenditures. Household net income per person was categorised as low (<20th percentile), middle (20th-80th) or high (>80th). Untaxed cigarette use was defined as self-reported consumption of cigarettes not subject to German taxes, including legally imported and illicit products. Descriptive analyses and logistic regression models examined expenditure patterns and associations with sociodemographic characteristics. RESULTS: People who exclusively smoke cigarettes report higher expenditures than those using other nicotine products. The median share of net household income spent on nicotine and tobacco products, including utensils, was 5.2% (IQR 2.8-11.0%); high-income, middle-income and low-income households spent 3.7% (IQR 1.7-6.1%), 5.2% (IQR 2.8-10.9%) and 11.0% (IQR 5.2-18.3%) of their income, respectively. 20.0% (95% CI 18.7% to 21.5%) of people who smoke cigarettes reported having smoked untaxed cigarettes in the past 12 months. The estimated share of untaxed cigarettes ranged from 0.67% (95% CI 0.65% to 0.68%) to 7.74% (95% CI 7.68% to 7.80%). CONCLUSION: The financial burden of nicotine and tobacco consumption is disproportionately high for low-income households, reinforcing existing social inequalities in Germany. TRIAL REGISTRATION NUMBER: DRKS00011322, DRKS00017157 and DRKS00028054.