European Journal of Epidemiology

, Volume 28, Issue 12, pp 959–971

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

  • Margarete C. Kulik
  • Rasmus Hoffmann
  • Ken Judge
  • Caspar Looman
  • Gwenn Menvielle
  • Ivana Kulhánová
  • Marlen Toch
  • Olof Östergren
  • Pekka Martikainen
  • Carme Borrell
  • Maica Rodríguez-Sanz
  • Matthias Bopp
  • Mall Leinsalu
  • Domantas Jasilionis
  • Terje A. Eikemo
  • Johan P. Mackenbach
MORTALITY

DOI: 10.1007/s10654-013-9860-5

Cite this article as:
Kulik, M.C., Hoffmann, R., Judge, K. et al. Eur J Epidemiol (2013) 28: 959. doi:10.1007/s10654-013-9860-5

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.

Keywords

SmokingMortalityInequalitiesModeling toolPAFInternational variation

Supplementary material

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Supplementary material 1 (DOC 34 kb)
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Supplementary material 2 (DOC 34 kb)
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Supplementary material 5 (DOC 766 kb)

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Margarete C. Kulik
    • 1
  • Rasmus Hoffmann
    • 1
  • Ken Judge
    • 2
  • Caspar Looman
    • 1
  • Gwenn Menvielle
    • 3
    • 4
  • Ivana Kulhánová
    • 1
  • Marlen Toch
    • 5
  • Olof Östergren
    • 6
  • Pekka Martikainen
    • 7
  • Carme Borrell
    • 8
  • Maica Rodríguez-Sanz
    • 8
  • Matthias Bopp
    • 9
  • Mall Leinsalu
    • 10
    • 11
  • Domantas Jasilionis
    • 12
  • Terje A. Eikemo
    • 1
  • Johan P. Mackenbach
    • 1
  1. 1.Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
  2. 2.Department for HealthUniversity of BathBathUK
  3. 3.Centre for Research in Epidemiology and Population Health (CESP), Epidemiology of Occupational and Social Determinants of HealthINSERM, U1018VillejuifFrance
  4. 4.University of Versailles Saint QuentinVersaillesFrance
  5. 5.Department of Sociology and Political ScienceNTNUTrondheimNorway
  6. 6.CHESSStockholm University/Karolinska InstitutetStockholmSweden
  7. 7.Population Research Unit, Department of Social ResearchUniversity of HelsinkiHelsinkiFinland
  8. 8.Agència de Salut Pública de BarcelonaBarcelonaSpain
  9. 9.Institute of Social and Preventive MedicineUniversity of ZurichZurichSwitzerland
  10. 10.Stockholm Centre on Health of Societies in TransitionSödertörn UniversityHuddingeSweden
  11. 11.Department of Epidemiology and BiostatisticsNational Institute for Health DevelopmentTallinnEstonia
  12. 12.Laboratory of Demographic DataMax Planck Institute for Demographic ResearchRostockGermany