Educational inequalities in smoking-attributable mortality in Europe: Understanding trends between 2000 and 2020

Area of Science:

• Public Health
• Epidemiology
• Social Determinants of Health

Background:

• Smoking is a major global cause of death and disease.
• Its health impacts are unequally distributed across socioeconomic groups.
• Understanding educational disparities in smoking-related mortality is crucial for public health policy.

Purpose of the Study:

• To investigate trends in educational inequalities in smoking-attributable mortality in Europe.
• To analyze changes in smoking's contribution to educational inequalities in partial life expectancy (2000-2020).

Main Methods:

• Longitudinal mortality follow-up using post-census data from ten European countries (2000-2020).
• Calculation of partial life expectancy (ages 50-80) by educational attainment.
• Estimation of smoking-attributable fraction (SAF) and decomposition of life expectancy differences using the continuous change model.

Main Results:

• For men, SAF decreased across all educational groups, but remained highest in lower education strata.
• For women, SAF increased over time, with a less pronounced educational gradient.
• Smoking contributed 0.2-2.3 years to educational differences in male life expectancy, decreasing over time; for women, it contributed -0.1-0.9 years, increasing or stabilizing.

Conclusions:

• Smoking continues to significantly drive educational inequalities in life expectancy, particularly for women.
• While smoking-attributable mortality declined in men, disparities persist.
• Targeted tobacco control measures are essential to address and reduce these growing socioeconomic health disparities, especially among women.