Two decades of inequalities in smoking prevalence, initiation and cessation in a southern European region: 1986-2007

Abstract

The smoking epidemic is still progressing in southern Europe. We aimed to analyse the magnitude and trend of social inequalities in smoking prevalence, initiation and cessation in the Basque Country, a southern European region, from 1986 to 2007, determining the patterns by sex and age. This was a cross-sectional time trend study on the population aged >24 years using the Basque Country Health Surveys of 1986, 1992, 1997, 2002 and 2007. Age-adjusted prevalence of current and ever smoking and cessation were calculated, as were relative index of inequality and population-attributable risk by occupational social class and educational level. Relative risk of starting smoking was estimated using Cox proportional hazard regression models. Calculations were performed separately by sex and for two age groups (25-44 years and >44 years). Men and young women in the Basque Country have evolved towards the last stage of the epidemic, with an increasing concentration of smoking in disadvantaged groups, by educational level, especially among the youngest population. In older women, smoking continues rising, especially among higher socio-economic groups, though differences between groups are diminishing. The role of initiation and cessation inequalities as determinants of smoking inequalities differed considerably by age and sex. Inequalities in smoking prevalence widened from 1986 to 2007 in the Basque Country, especially among the youngest population. The changing pattern of these inequalities and the different roles of initiation and cessation dynamics need to be taken into account to improve the results of tobacco control policies and their effect on smoking inequalities.