Global socioeconomic inequalities in tobacco use: internationally comparable estimates from the World Health Surveys
- 391 Downloads
To produce internationally comparable estimates of socioeconomic differences in tobacco exposure within low and middle-income countries.
We used data from 50 countries that participated in the World Health Surveys in 2002–2003. We measured two aspects of smoking: current smoking prevalence and accumulated pack-years of smoking. We used an asset-based approach to estimate permanent income. We measured absolute inequalities, separately by gender, across the entire socioeconomic distribution by using the concentration index and summarized the results and explored heterogeneity by meta-analysis.
The overall prevalence of current smoking was highest in Southeast Asia, the Western Pacific, and Europe, and lowest in Africa. Pack-years among current male smokers were highest in Europe. Wealthier men were generally less likely to be current smokers in all regions. However, there was substantial heterogeneity within each region, and in some countries (Georgia, Mexico, Mauritania) current smoking was greater among the more advantaged. Among currently smoking men socioeconomic differences for pack-years of smoking were generally much weaker than for smoking prevalence. Among women the concentration index in current smoking was largest and favored the poor in Europe (1.4, 95% CI 0.8, 2.1) but favored the rich in Southeast Asia and the Western Pacific. National income was generally not associated with the magnitude of socioeconomic gradients.
In low and middle-income countries there is substantial between and within-region heterogeneity in socioeconomic inequality in tobacco exposure that is not explained by national income. Our results imply that the relationship between socioeconomic position and smoking in poorer countries is dynamic and may not reflect the historical pattern in wealthier countries.
KeywordsTobacco Health inequalities Socioeconomic position Smoking Low- and middle-income countries
- 1.World Health Organization (2009) Global health risks: mortality and burden of disease attributable to selected major risks. World Health Organization, GenevaGoogle Scholar
- 13.Bobak M, Jha P, Nguyen S, Jarvis M (2000) Poverty and smoking. In: Jha P, Chaloupka F (eds) Tobacco control in developing countries. Oxford University Press, New York, pp 41–61Google Scholar
- 15.World Health Organization (2008) WHO report on the global tobacco epidemic, 2008. The MPOWER package. World Health Organization, GenevaGoogle Scholar
- 16.Ustun B, Chatterji S, Mechbal A, Murray CJ, groups Wc (2003) The world health surveys. In: Murray CJL, Evans DB (eds) Health systems performance assessment: debates, methods and empiricism. World Health Organization, Geneva, pp 797–808Google Scholar
- 17.World Health Organization (2008) World Health Survey instruments and related documents. http://www.who.int/healthinfo/survey/instruments/en/index.html. Accessed 15 July 2011
- 18.U.S. Public Health Service, Office of the Surgeon General, National Center for Chronic Disease Prevention and Health Promotion (2004) The health consequences of smoking: a report of the Surgeon General. U.S. Dept. of Health & Human Services, WashingtonGoogle Scholar
- 19.Ferguson BD, Tandon A, Gakidou E, Murray CJ (2003) Estimating permanent income using indicator variables. In: Murray CJL, Evans DB (eds) Health systems performance assessment: debates, methods and empiricism. World Health Organization, Geneva, p 927Google Scholar
- 21.Ferguson BD, Tandon A, Gakidou E, Murray CJL, Evans DB (2003) Estimating permanent income using indicator variables. Health systems performance assessment: debates, methods and empiricism. World Health Organization, Geneva, pp 747–760Google Scholar
- 23.Royston P (2005) Multiple imputation of missing values: update of ice. Stata J 5:527–536Google Scholar
- 24.Stata (2009) Stata multiple-imputation reference manual. Stata Press, TexasGoogle Scholar
- 25.Sen AK, Foster JE (1997) On economic inequality. Clarendon Press, OxfordGoogle Scholar
- 29.Sterne JAC (2009) Meta-analysis in Stata: an updated collection from the Stata journal, 1st edn. Strata Press, College StationGoogle Scholar
- 32.The World Bank (2011) World Development indicators. The World Bank. http://data.worldbank.org/data-catalog/world-development-indicators. Accessed 23 Nov 2010
- 37.Harper S, Lynch J, Meersman SC, Breen N, Davis WW, Reichman ME (2008) An overview of methods for monitoring social disparities in cancer with an example using trends in lung cancer incidence by area-socioeconomic position and race-ethnicity, 1992–2004. Am J Epidemiol 167:889–899PubMedCrossRefGoogle Scholar
- 41.World Health Organization (2012) Global adult tobacco survey (GATS). http://www.who.int/tobacco/surveillance/gats/en/index.html