RESEARCH PAPER

Reducing health disparity in Taiwan: quantifying the role of smoking

T Y Cheng¹, C P Wen¹, S P Tsai², W S I Chung¹, C C Hsu¹

¹ Division of Health Policy Research, National Health Research Institutes, Taipei, Taiwan
² The University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas, USA

Correspondence to:
Correspondence to:
Chi Pang Wen
MD, DrPH, Division of Health Policy Research, National Health Research Institutes, Taipei, Taiwan; cwengood{at}nhri.org.tw

Objective: To assess the impact of smoking disparities on health disparities, in terms of gap in life expectancy, in Taiwan cities and counties.

Methods: Using the decomposition method of life expectancy, the contribution of each disease category to the life expectancy gap was quantitatively expressed as the number of years of life. The smoking attributable fraction (SAF) was calculated for each city and county based on their respective smoking prevalence and relative risk for each smoking related disease. The smoking attributable gap (SAG) in life expectancy between two sites is the sum of the difference in SAF between two sites for each smoking related disease multiplied by the number of years this disease contributed to the life expectancy gap.

Results: Significant health and smoking disparities were present among the 23 cities and counties in Taiwan. These health disparities and smoking disparities were highly correlated (R² = 0.3676). Generally, the health gap increased with increasing smoking disparity. The disparity in smoking prevalence and intensity among cities and counties in Taiwan was responsible for up to 19% of the health disparity. The health disparity is also highly correlated (R² = 0.3745) with SAG in life expectancy.

Conclusions: Reducing smoking is important to health, and reducing the smoking disparity is also important for reducing the health disparity observed in Taiwan. The larger the health disparity is, the more important the smoking attributable disparity could be. The reduction of smoking disparities could be a realistic and cost effective way toward reducing health disparities.

Abbreviations: CDC, Centers for Disease Control and Prevention; HDG, health disparity gap; NHI, National Health Insurance; SAF, smoking attributable fraction; SAG, smoking attributable gap; SAM, smoking attributable mortality; SARS, severe acute respiratory syndrome; SES, socioeconomic status

Keywords: health disparity; smoking attributable fraction; smoking attributable gap

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This article has been cited by other articles:

• Wen, C. P., Tsai, S. P., Chung, W.-S. I. (2008). A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity. ANN INTERN MED 148: 258-267 [Abstract] [Full Text]  
• Wen, C P (2005). Facilitating the critical process in tobacco control. Tobacco Control 14: i1-i3 [Abstract] [Full Text]