Decomposition of socioeconomic inequalities in cigarette smoking: the case of Namibia

Zunda Chisha,Chijioke O Nwosu,John Ele-Ojo Ataguba

doi:10.1186/s12939-019-0912-7

Abstract

BackgroundNamibia has one of the highest levels of income inequality in the world. Increased smoking prevalence, especially among the youth, may leave the country facing the spectre of higher smoking-related disease prevalence in the years to come. This study examines socioeconomic inequalities in smoking in Namibia and explores the drivers of this inequality.MethodsData are obtained from the Namibia 2013 Demographic and Health Survey, a nationally representative survey. Concentration curves and indices are calculated for cigarette smoking prevalence and intensity to assess the respective inequalities. Smoking intensity is defined as the number of cigarette sticks smoked within the last 24 h before the survey. We use a decomposition technique to identify the contribution of various covariates to socioeconomic inequalities in smoking prevalence and intensity.ResultsThe concentration indices for socioeconomic inequality in cigarette smoking prevalence and smoking intensity are estimated at 0.021 and 0.135, respectively. This suggests that cigarette smoking is more prevalent among the wealthy and that they smoke more frequently compared to less wealthy Namibians. For smoking intensity, the biggest statistically significant contributors to inequality are marital status, wealth and region dummy variables while for smoking prevalence, education and place of dwelling (urban vs rural) are the main contributors.ConclusionWhile overall inequality in smoking prevalence and intensity is focused among the wealthy, the contribution of region of residence and education warrant some attention from policy makers. Based on our results, we suggest an assessment of compliance and enforcement of the Tobacco Products Control Act, that initially focuses on regions with reportedly low education statistics followed by an appropriate implementation strategy to address the challenges identified in implementing effective tobacco control interventions.

Highlights

Namibia has one of the highest levels of income inequality in the world
Understanding socioeconomic inequalities in smoking is imperative for developing appropriate interventions against smoking, especially in Lowand Middle-Income Country (LMIC)
The study notes a pattern of tobacco use that is concentrated among the wealthy, both in terms of the proportion of smokers and smoking intensity

Summary

Introduction

Namibia has one of the highest levels of income inequality in the world. Increased smoking prevalence, especially among the youth, may leave the country facing the spectre of higher smoking-related disease prevalence in the years to come. Smoking prevalence is anticipated to increase by 6.1 percentage points between 2010 and 2030, i.e. from 15.8% in 2010 to 21.9% in 2030 – the largest increase by region [1]. This increase will not be homogenous across population groups. Cigarette smoking prevalence in Namibia was estimated to be between 18.6% [7] and 21.6% [9] in 2015, mainly among young men. This is expected to increase to 26.9% by 2025. Between 2010 and 2016, the share of deaths due to chronic obstructive pulmonary disease, ischemic heart disease, stroke and diabetes all increased in Namibia [10]

Methods

Results

Discussion

Conclusion