Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis

Di Long, Johan Mackenbach, P (Pekka) Martikainen, O Lundberg, H Bronnum-Hansen, M Bopp, G (Giuseppe) Costa, K Kovacs, M Leinsalu, M Rodriguez-Sanz, G Menvielle, Wilma Nusselder

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Purpose: To study the trends of smoking-attributable mortality among the low and high educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality. Results: In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low- and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions: Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.

Original languageEnglish
Article number3
JournalPopulation Health Metrics
Issue number1
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
The permission of the Office for National Statistics to use the Longitudinal Study is gratefully acknowledged, as is the help provided by the staff of the Centre for Longitudinal Study Information & User Support (CeLSIUS). CeLSIUS is supported by the ESRC Census of Population Programme (Award Ref: ES/K000365/1). The authors alone are responsible for the interpretation of the data. This work contains statistical data from ONS which is Crown Copyright. The use of the ONS statistical data in this work does not imply the endorsement of the ONS in relation to the interpretation or analysis of the statistical data. This work uses research datasets that may not exactly reproduce National Statistics aggregates.

Funding Information:
The mortality data for Switzerland were obtained from the Swiss National Cohort, which is based on mortality and census data provided by the Federal Statistical Office and was supported by the Swiss National Science Foundation.

Funding Information:
Pekka Martikainen was funded by the Academy of Finland and MINDMAP, a European Commission HORIZON 2020 research and innovation action grant 667661. Mall Leinsalu was supported by the Estonian Research Council (grant PRG722).

Funding Information:
This study was conducted as part of the LIFEPATH project, which has received financial support from the European Commission (Horizon 2020 grant number 633666), and as part of the project “Longer life, longer in good health, working longer? Implications of educational differences for the pension system,” which has received financial support from Netspar (Network for Studies on Pensions, Aging and Retirement). Data were partly collected as part of the DEMETRIQ project, which also received support from the European Commission (grant number FP7-CP-FP grant no. 278511). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2021, The Author(s).


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