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Smoking and the potential for reduction of inequalities in mortality in Europe

  • MORTALITY
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Abstract

Socioeconomic inequalities in health and mortality remain a widely recognized problem. Countries with smaller inequalities in smoking have smaller inequalities in mortality, and smoking plays an important part in the explanation of inequalities in some countries. We identify the potential for reducing inequalities in all-cause and smoking-related mortality in 19 European populations, by applying different scenarios of smoking exposure. Smoking prevalence information and mortality data come from 19 European populations. Prevalence rates are mostly taken from National Health Surveys conducted around the year 2000. Mortality rates are based on country-specific longitudinal or cross-sectional datasets. Relative risks come from the Cancer Prevention Study II. Besides all-cause mortality we analyze several smoking-related cancers and chronic obstructive pulmonary disease/asthma. We use a newly-developed tool to quantify the changes in population health potentially resulting from modifying the population distribution of exposure to smoking. This tool is based on the epidemiological measure of the population attributable fraction, and estimates the impact of scenario-based distributions of smoking on educational inequalities in mortality. The potential reduction of relative inequality in all-cause mortality between those with high and low education amounts up to 26 % for men and 32 % for women. More than half of the relative inequality may be reduced for some causes of death, often in countries of Northern Europe and in Britain. Patterns of potential reduction in inequality differ by country or region and sex, suggesting that the priority given to smoking as an entry-point for tackling health inequalities should differ between countries.

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Acknowledgments

We thank the EURO-GBD-SE international project partners: Mortality data: Pekka Martikainen (Finland), Olle Lundberg (Sweden), Lisbeth Laursen (Denmark), Alaa Al-Hamad and Myer Glickman (England and Wales), Chris Dibben (Scotland), Patrick Deboosere (Belgium), Gwenn Menvielle (France), Matthias Bopp (Switzerland), Johannes Klotz (Austria), Carme Borrell (Barcelona, Spain), Santiago Esnaola (Basque Country, Spain), Enrique Regidor (Madrid, Spain), Giuseppe Costa (Turin, Italy), Annibale Biggeri (Tuscany, Italy), Jitka Rychtarikova (Czech Republic), Bogdan Wojtyniak (Poland), Domantas Jasilionis (Lithuania), Mall Leinsalu (Estonia). Risk factor prevalence data: Satu Helakorpi (Finland), Bo Burström (Sweden), Ola Ekholm (Denmark), Ken Judge (England), Chris Dibben (Scotland), J.J.M. Geurts (Netherlands), Jean Tafforeau (Belgium), Frédérique Ruchon (France), Centre Maurice Hallbawachs (France), Office Fédéral de la Statistique (Switzerland), Santiago Esnaola (Basque Country, Spain), Enrique Regidor (Spain), Giuseppe Costa (Turin, Italy), D. Dzurova (Czech Republic), Bogdan Wojtyniak (Poland), Jurate Klumbiene (Lithuania), Mare Tekkel (Estonia). The project was funded by the European Commission, through the Public Health Programme, grant agreement 20081309 and through the Netherlands Organization for Health Research and Development (ZonMw), project number 121020026.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands

    Margarete C. Kulik, Rasmus Hoffmann, Caspar Looman, Ivana Kulhánová, Terje A. Eikemo & Johan P. Mackenbach

  2. Department for Health, University of Bath, Bath, UK

    Ken Judge

  3. Centre for Research in Epidemiology and Population Health (CESP), Epidemiology of Occupational and Social Determinants of Health, INSERM, U1018, 94807, Villejuif, France

    Gwenn Menvielle

  4. University of Versailles Saint Quentin, 78035, Versailles, France

    Gwenn Menvielle

  5. Department of Sociology and Political Science, NTNU, Trondheim, Norway

    Marlen Toch

  6. CHESS, Stockholm University/Karolinska Institutet, Stockholm, Sweden

    Olof Östergren

  7. Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland

    Pekka Martikainen

  8. Agència de Salut Pública de Barcelona, Barcelona, Spain

    Carme Borrell & Maica Rodríguez-Sanz

  9. Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

    Matthias Bopp

  10. Stockholm Centre on Health of Societies in Transition, Södertörn University, Huddinge, Sweden

    Mall Leinsalu

  11. Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia

    Mall Leinsalu

  12. Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany

    Domantas Jasilionis

Authors
  1. Margarete C. Kulik
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  2. Rasmus Hoffmann
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  3. Ken Judge
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  4. Caspar Looman
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  6. Ivana Kulhánová
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  8. Olof Östergren
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  9. Pekka Martikainen
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  11. Maica Rodríguez-Sanz
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  12. Matthias Bopp
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  13. Mall Leinsalu
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  14. Domantas Jasilionis
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  15. Terje A. Eikemo
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  16. Johan P. Mackenbach
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Corresponding author

Correspondence to Margarete C. Kulik.

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This study was conducted for the Euro-GBD-SE Consortium.

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Kulik, M.C., Hoffmann, R., Judge, K. et al. Smoking and the potential for reduction of inequalities in mortality in Europe. Eur J Epidemiol 28, 959–971 (2013). https://doi.org/10.1007/s10654-013-9860-5

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  • DOI: https://doi.org/10.1007/s10654-013-9860-5

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