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Contribution of smoking to socioeconomic inequalities in mortality: a study of 14 European countries, 1990–2004
  1. G Gregoraci1,2,
  2. F J van Lenthe1,
  3. B Artnik3,
  4. M Bopp4,
  5. P Deboosere5,
  6. K Kovács6,
  7. C W N Looman1,
  8. P Martikainen7,
  9. G Menvielle8,
  10. F Peters1,
  11. B Wojtyniak9,
  12. R de Gelder1,
  13. J P Mackenbach1
  14. for the DEMETRIQ consortium
    1. 1Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
    2. 2Department of Medical and Biological Sciences, University of Udine, Institute of Hygiene and Clinical Epidemiology, Udine, Italy
    3. 3Department of Public Health, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
    4. 4Department of Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
    5. 5Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
    6. 6Demographic Research Institute of the Central Statistical Office, Budapest, Hungary
    7. 7Department of Sociology, University of Helsinki, Helsinki, Finland
    8. 8Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France
    9. 9Department Centre of Monitoring and Analyses of Population Health, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland
    1. Correspondence to Professor Johan P Mackenbach, Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam 3000 CA, The Netherlands; j.mackenbach{at}


    Background Smoking contributes to socioeconomic inequalities in mortality, but the extent to which this contribution has changed over time and driven widening or narrowing inequalities in total mortality remains unknown. We studied socioeconomic inequalities in smoking-attributable mortality and their contribution to inequalities in total mortality in 1990–1994 and 2000–2004 in 14 European countries.

    Methods We collected, harmonised and standardised population-wide data on all-cause and lung-cancer mortality by age, gender, educational and occupational level in 14 European populations in 1990–1994 and 2000–2004. Smoking-attributable mortality was indirectly estimated using the Preston-Glei-Wilmoth method.

    Results In 2000–2004, smoking-attributable mortality was higher in lower socioeconomic groups in all countries among men, and in all countries except Spain, Italy and Slovenia, among women, and the contribution of smoking to socioeconomic inequalities in mortality varied between 19% and 55% among men, and between −1% and 56% among women. Since 1990–1994, absolute inequalities in smoking-attributable mortality and the contribution of smoking to inequalities in total mortality have decreased in most countries among men, but increased among women.

    Conclusions In many European countries, smoking has become less important as a determinant of socioeconomic inequalities in mortality among men, but not among women. Inequalities in smoking remain one of the most important entry points for reducing inequalities in mortality.

    • Disparities
    • Socioeconomic status
    • Public policy

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