Smoking related disease risk, deprivation and lifestyle behaviours

Barbara Eberthb.eberth@abdn.ac.uk

(with D Olajide, A Ludbrook, P Craig, & D Stockton)

Motivation

• Smoking related diseases are an important source of preventable ill health and mortality

• Smoking related diseases affect all population groups, regardless of smoking status

• Smoking related disease risk is elevated by current or past tobacco smoke exposure, other lifestyle behaviours, and deprivation– ‘The causes of the causes’ (Marmot Review, 2010)

Objectives

• To model smoking related disease risk in the general population in Scotland

• To assess the contribution of deprivation to smoking related disease risk for the average individual in the population by smoking status

• To assess how this changes for the average individual by smoking status with – other healthy & unhealthy lifestyle behaviours – past experience of a smoking related disease

Data• Administratively linked Scottish Morbidity records & Scottish

Health Surveys (1995, 1998, 2003)• Definition of smoking related disease incidence

– ICD9 & ICD10 codes

• Analysis focus: – Risk of a smoking related disease incidence post survey

• Smoking status groups: – Never smokers– Never smokers exposed to Environmental tobacco smoke– Current smokers– Ex-smokers

Data• Deprivation:

– Scottish Index of Multiple Deprivation (SIMD) categorised into ordered quintiles• SIMD51 – least deprived• SIMD55 – most deprived

• Lifestyle behaviours:– Alcohol consumption

• Regular consumption within the recommended limit, regular consumption over the recommended limit, no or very occasional alcohol consumption

– Diet• BMI categories ( Underweight, normal weight, overweight, obese)

– Physical activity• Sports inactivity, light intensity sports, moderate intensity sports, vigorous intensity sports

• Other controls:– Gender, age, marital status, household composition, education,

employment status, general health, medical history, health board

Descriptive Statistics

All (N=21,096)

Variable Mean Smoking related disease incidence post survey 0.2362 Pre-survey smoking related disease incidence 0.1120 Never smoker 0.1624 Never smoker exposed to ETS 0.2331 Current smoker 0.3657 Ex-smoker 0.2389

Descriptive statistics

All (N=21,096)

Variable Mean Occasionally/never drinks alcohol* 0.297 Regularly drinks under the limit 0.4587 Regularly drinks over the limit 0.2377 Underweight 0.0162 Normal weight* 0.383 Overweight 0.377 Obese 0.2239 Inactive (Sports) 0.4993 Low intensity (Sports) 0.0884 Moderate intensity (Sports) 0.1507 Vigorous intensity (Sports) 0.2615 SIMD51 (least deprived) 0.1708 SIMD52 0.1953 SIMD53 0.2114 SIMD54 0.2114 SIMD55 (most deprived) 0.211

Results

Results

Results

Results

Conclusion• Predicted risk of disease disproportionately concentrated amongst individuals

from most deprived background regardless of smoking status group and highest for most deprived smokers– Implications for health inequalities

• Pre-existing smoking related disease incidence elevates the risk of future disease incidence substantially across the deprivation distribution – Target individuals with a pre-existing smoking related disease incidence/condition

• Healthy lifestyle behaviours are predicted to reduce smoking related disease risk across the deprivation distribution regardless of smoking status (gain smallest for smokers)– Smoking cessation in combination with changes in other lifestyle behaviours

• Unhealthy lifestyle behaviours predicted to increase smoking related disease risk across the deprivation distribution regardless of smoking status– Unhealthy lifestyle behaviours are bad for you → Healthy lifestyles are good for you– Substantial gains in predicted risks with adoption of healthy behaviours

Acknowledgements

• The receipt of the financial support from the MRC National Preventive Research Initiative Phase 2 grant G0701874 is acknowledged gratefully; see http://www.npri.org.uk

• The Funding Partners relevant to this award are:– British Heart Foundation; Cancer Research UK; Department of Health;

Diabetes UK; Economic and Social Research Council; Medical Research Council; and Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office, Scottish Government Health Directorates; The Stroke Association; Welsh Assembly Government and World Cancer Research Fund.