The changing contribution of smoking to educational differences in life expectancy: indirect estimates for Finnish men and women from 1971 to 2010

Abstract

Background We estimate the contribution of smoking to educational differences in mortality and life expectancy between 1971 and 2010 in Finland. Methods Eight prospective datasets with baseline in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005 and each linked to a 5-year mortality follow-up were used. We calculate life expectancy at age 50 with and without smoking-attributable mortality by education and gender. Estimates of smoking-attributable mortality were based on an indirect method that used lung cancer mortality as a proxy for the impact of smoking on mortality from all other causes. Results Smoking-attributable deaths constituted about 27% of all male deaths above age 50 in the early 1970s and 17% in the period 2006-2010; these figures were 1% and 4% among women, respectively. The life expectancy differential between men with basic versus high education increased from 3.4 to 4.7 years between 1971-75 and 2006-10. In the absence of smoking, these differences would have been 1.5 and 3.4 years, 1.9 years (55%) and 1.3 years (29%) less than those observed. Among women, educational differentials in life expectancy between the most and least educated increased from 2.5 to 3.0 years. This widening was nearly entirely accounted for by the increasing impact of smoking. Among women the contribution of smoking to educational differences had increased from being negligible in 1971-75 to 16% in 2006-2010. Conclusions Among men, the increase in educational differences in mortality in the past decades was driven by factors other than smoking. However, smoking continues to have a major influence on educational differences in mortality among men and its contribution is increasing among women.

174 Level of education and mortality after radical prostatectomy

“…27 In our study, the overall mortality difference between men with high versus low level of education was narrowly equivalent to one point of the Charlson comorbidity score ( Table 3). With the qualification that the 50% overall mortality level has no yet been reached, it may be estimated that the medium-term difference between the overall mortality curves of patients with or without a higher level of education was approximately 3 years (Figure 1), which was in a similar range as in comparable studies (3.8 years, 6 2.4-3.9 years, 9 3.4-4.7 years, 24 3.4 years, 28 and 1.4-2.8 years, 29 respectively). Such a relatively large mortality difference may be clinically significant, particularly since the level of education may be used supplementary to age, ASA classification (evaluating the general physical status focused on the perioperative risk), Charlson score (counting and weighting of concomitant diseases), and smoking status ( Table 3) to estimate the further life expectancy in candidates for radical prostatectomy.…”

“…PSA: prostate-specific antigen; ASA: American Society of Anesthesiologists Smoking is another risk factor with higher prevalence in this population 23 and has been held responsible for a portion of the lower education-related life year loss. 8,24 The higher mean body mass index combined with the increased prevalence of smoking may therefore in part explain the increased second cancer and noncancer mortality rates in patients with a lower level of education. Since a lower level of education was an independent predictor of mortality after controlling for age, smoking status, body mass index, and comorbidity, an association with further unmeasured (for instance occupational, environmental or lifestyle-related) risk factors may be hypothesized.…”

Changes Over Time in Absolute and Relative Socioeconomic Differences in Smoking: A Comparison of Cohort Studies From Britain, Finland, and Japan

“…The observed socioeconomic differences in smoking will contribute to subsequent inequalities in lung and other smoking-related diseases and mortality. 13,[52][53][54] Population approaches to smoking reduction should be augmented by policies to improve success across all social classes in Britain, Finland and Japan and to narrow socioeconomic differences in smoking in Britain and Finland.…”

“…51 Our observations on British and Finnish men and women reconfirm the need for further measures that target smoking in general as well as the large and persistent socioeconomic differences. It is well-known that smoking is a key contributor to socioeconomic differences in morbidity and mortality in western countries, 49,52,53 and the persisting socioeconomic differences in smoking suggest that smoking likely contributes to these differences also in the future. This is one more incentive for antismoking measures in general and across all social classes.…”

The role of smoking on mortality compression

“…The extent to which differences in smoking behavior are responsible for socioeconomic differences in mortality has yielded somewhat varying results, depending in large part on the methodology used, and the countries and age ranges examined (Denney et al 2010;Jha et al 2006;Marmot 2006;Martikainen et al 2013). Using direct methods of estimating smoking-attributable mortality, smoking was estimated to account for around a quarter of the educational gap in male adult mortality among British civil servants (Marmot 2006) and in the USA (Denney et al 2010), although when further refined by age, the latter study found that this figure was as high as 44% among middle-aged men.…”