Smoking is a much more significant cause of health inequalities than wealth or social class, research claims. A new study shows well-off smokers die earlier than poor non-smokers, plus women smokers die earlier than male non-smokers cancelling out the life expectancy advantage women usually have over men.
Researchers also found that quitting smoking, even if in middle-age, can have a huge impact on life expectancy, with ex-smokers' survival rates closer to non-smokers than those who continue to smoke. An inquiry by the Commons health select committee into health inequalities, due to be published soon, is also expected to flag up the importance of quitting smoking in order to narrow the health gap between rich and poor.
Commenting on the today's report, ASH chief executive, Deborah Arnott, said: "The measures in the health bill to deter children from taking up smoking such as a ban on the display of tobacco products in shops and a ban on tobacco vending machines are a welcome step forward. But this study shows that if the government is to succeed in reducing health inequalities in the next generation it needs to have a comprehensive strategy to drive down smoking rates. This should include sufficient resources to ensure people who want to stop smoking are given all the help they need."
The study was based on the residents of Scottish towns Renfrew and Paisley. In 1972 residents, then aged between 45 and 64 years, from the towns were invited to participate. After 28 years of follow-up, 56 per cent of women and 36 per cent of men who had never smoked in social classes IV and V were still alive, compared with only 41 per cent of women and 24 per cent of men who smoked in social classes I and II.
Published 17 February 2009, doi:10.1136/bmj.b480
Cite this as: BMJ 2009;338:b480
Research
Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study
Laurence Gruer, director of public health science1, Carole L Hart, research fellow2, David S Gordon, head of public health observatory division1, Graham C M Watt, professor of general practice3
1 NHS Health Scotland, Elphinstone House, Glasgow G2 2AF, 2 Public Health and Health Policy, Division of Community-based Sciences, University of Glasgow, Glasgow G12 8RZ, 3 General Practice and Primary Care, Division of Community-based Sciences, University of Glasgow, Glasgow G12 9LX
Correspondence to: L Gruer Laurence.Gruer@health.scot.nhs.uk
Design A cohort observational study.
Setting Renfrew and Paisley, two towns in west central Scotland.
Participants 8353 women and 7049 men aged 45-64 years recruited in 1972-6 (almost 80% of the population in this age group). The cohort was divided into 24 groups by sex (male, female), smoking status (current, former, or never smokers), and social class (classes I + II, III non-manual, III manual, and IV +V) or deprivation category of place of residence.
Main outcome measure Relative mortality (adjusted for age and other risk factors) in the different groups; Kaplan-Meier survival curves and survival rates at 28 years.
Results Of those with complete data, 4387/7988 women and 4891/6967 men died over the 28 years. Compared with women in social classes I + II who had never smoked (the group with lowest mortality), the adjusted relative mortality of smoking groups ranged from 1.7 (95% confidence interval 1.3 to 2.3) to 4.2 (3.3 to 5.5). Former smokers’ mortalities were closer to those of neversmokers than those of smokers. By social class (highest first), age adjusted survival rates after 28 years were 65%, 57%, 53%, and 56% for female never smokers; 41%, 42%, 33%, and 35% for female current smokers; 53%, 47%, 38%, and 36% for male never smokers; and 24%, 24%, 19%, and 18% for male current smokers. Analysis by deprivation category gave similar results.
Conclusions Among both women and men, never smokers had much better survival rates than smokers in all social positions. Smoking itself was a greater source of health inequality than social position and nullified women’s survival advantage over men. This suggests the scope for reducing health inequalities related to social position in this and similar populations is limited unless many smokers in lower social positions stop smoking.
© Gruer et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
http://creativecommons.org/licenses/by-nc/2.0/
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