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Global socioeconomic inequalities in tobacco use: internationally comparable estimates from the World Health Surveys

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Abstract

Objective

To produce internationally comparable estimates of socioeconomic differences in tobacco exposure within low and middle-income countries.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

We thank the Institute for Health Metrics and Evaluation (http://www.healthmetricsandevaluation.org) for providing us with the estimates of permanent income that were used in these analyses. This work was supported by the Canadian Institutes for Health Research (191612). Sam Harper was supported by a Chercheur-boursier from the Fonds de la Recherche en Sante du Quebec (FRSQ). The funders had no role in the study design, data gathering and analysis, interpretation of data, decision to publish, or preparation of the manuscript. The corresponding author had full access to all data that were analyzed and had final responsibility for the decision to submit the report for publication.

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Authors and Affiliations

  1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Room 34B, Montreal, QC, Canada

    Sam Harper & Brittany McKinnon

Authors
  1. Sam Harper
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  2. Brittany McKinnon
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Correspondence to Sam Harper.

Appendix

Appendix

See Figs. 3,4 and Tables 3, 4.

Fig. 3
figure 3

World Health Organization regional offices (source: http://commons.wikimedia.org/wiki/File:World_Health_Organisation_regional_offices.png, accessed 15 July 2011)

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Fig. 4
figure 4

Estimated effect of log GDP per capita ($10,000s) on absolute socioeconomic inequalities in tobacco exposure. Note: size of bubble based on study precision (inverse of within-study variance)

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Table 3 Countries involved in the World Health Surveys classified by World Health Organization and 2003 World Bank lending regions
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Table 4 List of shared and country-specific assets used in the asset-based index of permanent income, World Health Survey (2002–2003)
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Harper, S., McKinnon, B. Global socioeconomic inequalities in tobacco use: internationally comparable estimates from the World Health Surveys. Cancer Causes Control 23 (Suppl 1), 11–25 (2012). https://doi.org/10.1007/s10552-012-9901-5

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