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The products also face a sharp economic divide, in which high-income countries have tended to stray from the use of cigarettes in recent decades, while low-income countries create markets in which the products can thrive
and 3) Epidemiological change, which encompasses changes in the underlying age-specific risk or disease rates, reflecting the cumulative impact of factors such as variations in smoking prevalence, exposure intensity, diagnostic practices, and treatment effectiveness over time
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