Changing social inequalities in smoking, obesity and cause-specific mortality: Cross-national comparisons using compass typology

Abstract

Background In many countries smoking rates have declined and obesity rates have increased, and social inequalities in each have varied over time. At the same time, mortality has declined in most high-income countries, but gaps by educational qualification persist-at least partially due to differential smoking and obesity distributions. This study uses a compass typology to simultaneously examine the magnitude and trends in educational inequalities across multiple countries in: a) smoking and obesity; b) smoking-related mortality and c) cause-specific mortality. Methods Smoking prevalence, obesity prevalence and cause-specific mortality rates (35-79 year olds by sex) in nine European countries and New Zealand were sourced from between 1980 and 2010. We calculated relative and absolute inequalities in prevalence and mortality (relative and slope indices of inequality, respectively RII, SII) by highest educational qualification. Countries were then plotted on a compass typology which simultaneously examines trends in the population average rates or odds on the x-axis, RII on the Y-axis, and contour lines depicting SII. Findings Smoking and obesity. Smoking prevalence in men decreased over time but relative inequalities increased. For women there were fewer declines in smoking prevalence and relative inequalities tended to increase. Obesity prevalence in men and women increased over time with a mixed picture of increasing absolute and sometimes relative inequalities.

Education-related inequalities in cause-specific mortality: first estimates for Australia using individual-level linked census and mortality data

“… 5 , 25 , 26 Many studies do not report RIIs, despite this being the recommended method for international comparisons. 6 However, our RIIs were generally higher than those reported for those aged 35-79 years in European countries covering the period from 1990s to the early 2000s and for New Zealand in the period 2006-11, 4 , 28 although direct comparisons remain difficult given that previously reported RIIs are generally not age stratified. The fact that the relative inequality estimates observed in this study are generally larger than observed in comparable countries may reflect, at least in part, a greater concentration of disadvantage among those with lower levels of education in Australia 29 , 30 and/or larger socioeconomic differences in risk factors in Australia compared with other countries (e.g.…”

Association between health behaviors and depression: findings from the 2019 Brazilian National Health Survey

“…The score for each question varied according to the frequency of symptoms, from zero (no day) to three (almost every day), which generates a maximum score of 27. The sum of items allows for grading between no depression (0-4), mild depression (5)(6)(7)(8)(9), moderate depression (10)(11)(12)(13)(14), moderately severe depression (15)(16)(17)(18)(19) and severe depression (20-27) 16 . Individuals with ten or more points were considered "with depression".…”

“…The association of health-related behaviors with chronic diseases and early mortality is widely recognized 1,2 , and an increase in social inequalities in mortality 3,4 and in health-related behaviors has been detected in recent decades 5,6 . These findings highlight the need to better understand the role of health behaviors in increasing inequalities in morbidity and mortality 7 and draws attention to the importance of the quality of the health programs implemented to prevent unhealthy behaviors.…”

Changes in prevalence and in educational inequalities in Brazilian health behaviors between 2013 and 2019

“…The control measures implemented tend to reach more affluent segments of the population in a first step, which can lead to an increase in inequalities 13 . To reduce health inequalities, tobacco control must focus essentially on vulnerable segments of society 16 .…”

“…Despite reductions in several unhealthy behaviors, studies have suggested an increase in social inequality in the prevalence of these behaviors in many countries 15,16 . In recent decades, several developed countries have registered an increase in inequalities in mortality among socioeconomic strata 17 .…”