Background:
Although tobacco taxation has been shown to improve infant survival in high-income countries, evidence on the impact of different taxation levels and structures at a global level is lacking.

Objective:
To explore longitudinal associations of cigarette taxes with neonatal and infant mortality globally.

Methods:
We conducted country-level panel regressions using annual mortality data and biennial WHO tobacco taxation data (2008–2018) to explore the association between type of taxes (i.e. specific cigarette taxes, ad valorem taxes, and other taxes, import duties and VAT) and neonatal/infant mortality. Covariates included other WHO recommended tobacco control policies, socioeconomic, healthcare, and air quality, variables.

Results:
In a total of 159 countries, we found that a 10 percentagepoint increase in total cigarette tax as a percentage of the retail price was associated with a 2.6% (95% CI: 1.9– 3.2) decrease in neonatal mortality and a 1.9% (95% CI: 1.3–2.6) decrease in infant mortality globally. Based on the above, we estimated that a global 10 percentage-point increase in total tax would have prevented 77946 (95% CI: 49555–106130) infant deaths including 64177 (95% CI: 46570–81653) neonatal deaths in 2018. A 10 percentage-point increase in specific tax and ad valorem tax was associated with a similar level of reduction in neonatal (2.3% vs 2.5%, respectively) and infant mortality (1.7% in both cases).

Conclusions:
Increasing cigarette taxes was associated with lower neonatal and infant mortality across 159 countries. Hence, meeting the WHO recommendations for tobacco taxation (at least 75% of the retail price) could provide great benefits, especially in countries with low taxation levels and high infant mortality.