Social inequalities in tobacco-attributable mortality in Spain. The intersection between age, sex and educational level

• Published in: PloS one Vol. 15; no. 9; p. e0239866
• Main Authors: Haeberer, Mariana, León-Gómez, Inmaculada, Pérez-Gómez, Beatriz, Téllez-Plaza, María, Pérez-Ríos, Mónica, Schiaffino, Anna, Rodríguez-Artalejo, Fernando, Galán, Iñaki
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.09.2020; Public Library of Science (PLoS)
• Subjects: Adult; Age; Age Factors; Aged; Biology and Life Sciences; Cancer; Cardiovascular diseases; Cohort Studies; Demographic aspects; Disease; Education; Educational Status; Fatalities; Female; Generalized linear models; Health aspects; Health disparities; Health risks; Health surveys; Humans; Inequality; Male; Mathematical analysis; Medical research; Medicine and Health Sciences; Men; Middle Aged; Mortality; Neoplasms - mortality; Nicotiana - adverse effects; Nutrition research; Patient outcomes; People and places; Population; Prevalence; Respiratory diseases; Respiratory tract diseases; Risk assessment; Risk Factors; Risk management; Sex; Sex Factors; Smoking; Smoking - epidemiology; Smoking - mortality; Social aspects; Social Class; Social medicine; Social Sciences; Socioeconomic factors; Spain - epidemiology; Statistical analysis; Teaching methods; Tobacco; Women; Womens health; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0239866

First study of social inequalities in tobacco-attributable mortality (TAM) in Spain considering the joint influence of sex, age, and education (intersectional perspective). Data on all deaths due to cancer, cardiometabolic and respiratory diseases among people aged ≥35 years in 2016 were obtained from the Spanish Statistical Office. TAM was calculated based on sex-, age- and education-specific smoking prevalence, and on sex-, age- and disease-specific relative risks of death for former and current smokers vs lifetime non-smokers. As inequality measures, the relative index of inequality (RII) and the slope index of inequality (SII) were calculated using Poisson regression. The RII is interpreted as the relative risk of mortality between the lowest and the highest educational level, and the SII as the absolute difference in mortality. The crude TAM rate was 55 and 334 per 100,000 in women and men, respectively. Half of these deaths occurred among people with the lowest educational level (27% of the population). The RII for total mortality was 0.39 (95%CI: 0.35-0.42) in women and 1.61 (95%CI: 1.55-1.67) in men. The SII was -41 and 111 deaths per 100,000, respectively. Less-educated women aged <55 years and men (all ages) showed an increased mortality risk; nonetheless, less educated women aged ≥55 had a reduced risk. TAM is inversely associated with educational level in men and younger women, and directly associated with education in older women. This could be explained by different smoking patterns. Appropriate tobacco control policies should aim to reduce social inequalities in TAM.