Smoking and Inequalities in Mortality in 11 European Countries: A Birth Cohort Analysis (original) (raw)
Related papers
Tobacco Control
Background Smoking contributes to socioeconomic inequalities in mortality, but the extent to which this contribution has changed over time and driven widening or narrowing inequalities in total mortality remains unknown. We studied socioeconomic inequalities in smoking-attributable mortality and their contribution to inequalities in total mortality in 1990-1994 and 2000-2004 in 14 European countries. Methods We collected, harmonised and standardised population-wide data on all-cause and lung-cancer mortality by age, gender, educational and occupational level in 14 European populations in 1990-1994 and 2000-2004. Smoking-attributable mortality was indirectly estimated using the Preston-Glei-Wilmoth method. Results In 2000-2004, smoking-attributable mortality was higher in lower socioeconomic groups in all countries among men, and in all countries except Spain, Italy and Slovenia, among women, and the contribution of smoking to socioeconomic inequalities in mortality varied between 19% and 55% among men, and between −1% and 56% among women. Since 1990-1994, absolute inequalities in smoking-attributable mortality and the contribution of smoking to inequalities in total mortality have decreased in most countries among men, but increased among women. Conclusions In many European countries, smoking has become less important as a determinant of socioeconomic inequalities in mortality among men, but not among women. Inequalities in smoking remain one of the most important entry points for reducing inequalities in mortality.
Inequalities in lung cancer mortality by the educational level in 10 European populations
European Journal of Cancer, 2004
Previous studies have shown that due to differences in the progression of the smoking epidemic European countries differ in the direction and size of socioeconomic variations in smoking prevalence. We studied differences in the direction and size of inequalities in lung cancer mortality by the educational level of subjects in 10 European populations during the 1990's. We obtained longitudinal mortality data by cause of death, age, sex and educational level for 4 Northern European populations (England/Wales, Norway, Denmark, Finland), 3 continental European populations (Belgium, Switzerland, Austria), and 3 Southern European populations (Barcelona, Madrid, Turin). Age-and sex-specific mortality rates by educational level were calculated, as well as the age-and sex-specific mortality rate ratios. Patterns of educational inequalities in lung cancer mortality suggest that England/Wales, Norway, Denmark, Finland and Belgium are the farthest advanced in terms of the progression of the smoking epidemic: these populations have consistently higher lung cancer mortality rates among the less educated in all age-groups in men, including the oldest men, and in all age-groups in women up to those aged 60-69 years. Madrid appears to be less advanced, with less educated men in the oldest age-group and less educated women in all age-groups still benefiting from lower lung cancer mortality rates. Switzerland, Austria, Turin and Barcelona occupy intermediate positions. The lung cancer mortality data suggest that inequalities in smoking contribute substantially to the educational differences in total mortality among men in all populations, except Madrid. Among women, these contributions are probably substantial in the Northern European countries and in Belgium, but only small in Switzerland, Austria, Turin and Barcelona, and negative in Madrid. In many European countries, policies and interventions that reduce smoking in less educated groups should be one of the main priorities to tackle socioeconomic inequalities in mortality. In some countries, particularly in Southern Europe, it may not be too late to prevent women in less educated groups from taking up the smoking habit, thereby avoiding large inequalities in mortality in the future in these countries. #
2011
Changes in social inequality in smoking-attributable adult male mortality between 1986 and 2001 in four developed countries By Sonica Singhal Master of Science Institute of Medical Sciences University of Toronto 2011 Social inequalities exist in smoking-attributable mortality rates of males. Change in these social inequalities in the past two decades in developed countries remains uncertain. This study was conducted in Canada, France, Poland, and Switzerland to quantify differences in smoking-attributable mortality rates, at ages 35-69 years, among different social strata in recent years and to examine the changes in social inequalities in these rates between 1986 and 2001. Analyses included 377,878 deaths from a total population of 13,482,210 males of these four countries. Smoking-attributable mortality rates reduced in all strata over the comparative time periods, in all countries, except France. This work specifically focuses to fill the gap in knowledge about whether tobacco con...
The negative association between education and mortality is well established in international research. The harmful effect of smoking on health is well known. However, the contribution of smoking to educational inequality in mortality varies across studies, and in some studies, the contribution is negligible. This paper demonstrates the use of an analytical approach to provide one explanation for this phenomenon. Analysing nationally representative survey data for two cohorts of Australian women born in 1920-1928 and 1945-1951 respectively, we found that in the 1994-2006 period, the less educated are subject to higher mortality by 38-50%. In the total sample, the smoking contribution to excess mortality due to lower education is negligible. However, when the cohorts are analysed independently, the smoking contribution ranges from -13% among those born in 1920-1928 to +23% among those born in [1945][1946][1947][1948][1949][1950][1951]. The smoking contribution is only seen in the cohort-specific analysis because smoking is more prevalent among tertiary degree holders in the earlier cohort but more prevalent among less educated women in the later cohort. The disaggregated analytical approach taken here deserves further attention in research on inequality.
Socioeconomic inequalities in lung cancer mortality in 16 European populations
Lung Cancer, 2009
Objectives: This paper aims to describe socioeconomic inequalities in lung cancer mortality in Europe and to get further insight into socioeconomic inequalities in lung cancer mortality in different European populations by relating these to socioeconomic inequalities in overall mortality and smoking within the same or reference populations. Particular attention is paid to inequalities in Eastern European and Baltic countries. Methods: Data were obtained from mortality registers, population censuses and health interview surveys in 16 European populations. Educational inequalities in lung cancer and total mortality were assessed by direct standardization and calculation of two indices of inequality: the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). SIIs were used to calculate the contribution of inequalities in lung cancer mortality to inequalities in total mortality. Indices of inequality in lung cancer mortality in the age group 40-59 years were compared with indices of inequalities in smoking taking into account a time lag of 20 years. Results: The pattern of inequalities in Eastern European and Baltic countries is more or less similar as the one observed in the Northern countries. Among men educational inequalities are largest in the Eastern European and Baltic countries. Among women they are largest in Northern European countries. Whereas among Southern European women lung cancer mortality rates are still higher among the high educated, we observe a negative association between smoking and education among young female adults. The contribution of lung cancer mortality inequalities to total mortality inequalities is in most male populations more than 10%. Important smoking inequalities are observed among young adults in all populations. In Sweden, Hungary and the Czech Republic smoking inequalities among young adult women are larger than lung cancer mortality inequalities among women aged 20 years older. Conclusions: Important socioeconomic inequalities exist in lung cancer mortality in Europe. They are consistent with the geographical spread of the smoking epidemic. In the next decades socioeconomic inequalities in lung cancer mortality are likely to persist and even increase among women. In Southern European countries we may expect a reversal from a positive to a negative association between socioeconomic status and lung cancer mortality. Continuous efforts are necessary to tackle socioeconomic inequalities in lung cancer mortality in all European countries.
Journal of Epidemiology & Community Health, 2014
Background A large part of the socioeconomic mortality gradient can be statistically accounted for by social patterning of adult health behaviours. However, this statistical explanation does not consider the early life origins of unhealthy behaviours and increased mortality risk. Methods Analysis is based on 2132 members of the MRC National Survey of Health and Development with mortality follow-up and complete data. Smoking behaviour was summarised by pack-years of exposure. Socioeconomic circumstances were measured in childhood (father's social class (age 4), maternal education (age 6)) and age 26 (education attainment, home ownership, head of household social class). We estimated the direct effect of early circumstances, the indirect effect through smoking and the independent direct effect of smoking on inequality in all-cause mortality from age 26 to 66. Results Mortality risk was higher in those with lower socioeconomic position at age 26, with a sex-adjusted HR (relative index of inequality) of 1.97 (95% CI 1.18 to 3.28). Smoking and early life socioeconomic indicators together explained 74% of the socioeconomic gradient in mortality (the gradient). Early life circumstances explained 47% of the gradient, 23.5% directly and 23.0% indirectly through smoking. The explanatory power of smoking behaviour for the gradient was reduced from 50.8% to 28% when early life circumstances were added to the model. Conclusions Early life socioeconomic circumstances contributed importantly to social inequality in adult mortality. Our life-course model focusing on smoking provides evidence that social inequalities in health will persist unless prevention strategies tackle the intergenerational transmission of disadvantage and risk.
The role of smoking in changes in the survival curve: an empirical study in 10 European countries
Annals of epidemiology, 2015
We examined the role of smoking in the two dimensions behind the time trends in adult mortality in European countries, that is, rectangularization of the survival curve (mortality compression) and longevity extension (increase in the age-at-death). Using data on national sex-specific populations aged 50 years and older from Denmark, Finland, France, West Germany, Italy, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom, we studied trends in life expectancy, rectangularity, and longevity from 1950 to 2009 for both all-cause and nonsmoking-related mortality and correlated them with trends in lifetime smoking prevalence. For all-cause mortality, rectangularization accelerated around 1980 among men in all the countries studied, and more recently among women in Denmark and the United Kingdom. Trends in lifetime smoking prevalence correlated negatively with both rectangularization and longevity extension, but more negatively with rectangularization. For nonsmoking-relat...
Does the association between smoking and mortality differ by educational level?
Social Science & Medicine, 2012
Some researchers suggest that the effect of smoking on health depends on socioeconomic status; while others purport that the effect of smoking on health is similar across all social groups. This question of the interaction between smoking and socioeconomic status is important to an improved understanding of the role of smoking in the social gradient in mortality and morbidity. For this purpose, we examined whether educational level modifies the association between smoking and mortality. Information on smoking by age, gender and educational level was extracted from the Belgian Health Interview Surveys of 1997 and 2001. The mortality follow up of the survey respondents was reported until December 2010. A Poisson regression was used to estimate the hazard ratio of mortality for heavy smokers, light smokers, and former smokers compared with never smokers by educational level controlling for age and other confounders. Among men, we found lower hazard ratios in the lowest educational category compared with the intermediate and high-educated categories. For instance, for heavy smokers, the hazard ratios were 2.59 (1.18e5.70) for those with low levels of education, 4.03 (2.59e6.26) for those with intermediate levels of education and 3.78 (1.52e9.43) for the highly educated. However, the interaction between smoking and education was not statistically significant. For women, the hazard ratios were not significant for any educational category except for heavy smokers with intermediate levels of education. Also here the interaction was not statistically significant. Our results support the hypothesis that educational attainment does not substantially influence the association between smoking and mortality.
Trends in smoking behaviour between 1985 and 2000 in nine European countries by education
Journal of Epidemiology and Community Health, 2005
Objective: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. Design: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. Setting: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. Participants: 451 386 non-institutionalised men and women 25-79 years old. Main outcome measures: Smoking status, daily quantity of cigarettes consumed by smokers. Results: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. Conclusions: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.