Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Nicotine Tob Res. 2019 Oct 26;21(11):1539-1546. doi: 10.1093/ntr/nty203.
Higher smoking rates and lower cessation rates among the poor compared to the rich are evident in high-income countries. In low and middle-income countries (LMICs), many of which are in the early stages of tackling the tobacco epidemic, more knowledge is required of the socioeconomic inequalities in smoking. This is especially the case for upper-middle-income countries, where smoking prevalence is highest. This study examines trends in the socioeconomic gradient in smoking and cessation among adults across a period of rapid economic development in Malaysia, an LMIC with an upper-middle-income economy.
The socioeconomic trends in smoking were analyzed using data from cross-sectional National Health and Morbidity Surveys for the years 1996, 2006, and 2011. Household per capita income was used as a measure of socioeconomic position. As a measure of inequality, the concentration index that quantified the degree of socioeconomic inequality in a health outcome was computed. Smoking was assessed in current and former smokers. The study population was examined by gender, region, and age group.
This study found a trend of an increasingly higher smoking prevalence among the poor and higher cessation rates among the rich. With the exception of younger women in Peninsular Malaysia, the socioeconomic gradient in current smoking is concentrated among the poor. For former smokers, especially men, distributions across the years were mostly concentrated among the rich.
It is important to ensure that health policies, programs, and interventions consider the potential impact of the socioeconomic patterning in smoking on equity in health.
Findings on the socioeconomic gradient in smoking and cessation from Malaysia across a period of rapid economic development will contribute to addressing the paucity of knowledge on the socioeconomic gradient of smoking and cessation in other progressing LMICs. This study provides evidence from an upper-middle-income country, of an increasing trend of smoking among the poor and an increasing trend of cessation rates among the rich, particularly for men. We found opposing trends for younger adult women in the more developed, Peninsular Malaysia. More rich young women were found to have taken up smoking compared to socioeconomically less advantaged young women.
高收入国家中，穷人的吸烟率较高，戒烟率较低，而富人则相反。在中低收入国家（LMICs），许多国家正处于应对烟草流行的早期阶段，因此需要更多了解吸烟方面的社会经济不平等问题。对于中上收入国家来说，这种需求尤其迫切，因为这些国家的吸烟率最高。本研究考察了在马来西亚这一中上收入国家经历快速经济发展的时期内，成年人吸烟和戒烟方面的社会经济梯度趋势。
本研究使用来自 1996 年、2006 年和 2011 年全国健康和发病率调查的横断面数据，分析了吸烟的社会经济趋势。家庭人均收入被用作社会经济地位的衡量标准。使用集中指数作为不平等衡量标准，量化健康结果的社会经济不平等程度。吸烟情况通过当前吸烟者和曾经吸烟者进行评估。研究人群按性别、地区和年龄组进行检查。
本研究发现，穷人的吸烟率呈上升趋势，而富人的戒烟率呈上升趋势。除了马来半岛的年轻女性外，当前吸烟的社会经济梯度集中在穷人中。对于曾经吸烟者，尤其是男性，多年来的分布主要集中在富人中。
确保卫生政策、计划和干预措施考虑到吸烟的社会经济模式对健康公平的潜在影响非常重要。
马来西亚在快速经济发展时期吸烟和戒烟的社会经济梯度的发现，将有助于解决其他进展中的 LMICs 中吸烟和戒烟的社会经济梯度知识匮乏的问题。本研究提供了来自中上收入国家的证据，表明穷人的吸烟率呈上升趋势，富人的戒烟率呈上升趋势，特别是对男性而言。我们发现，在更发达的马来半岛，年轻成年女性的情况则相反。与社会经济地位较低的年轻女性相比，更多的富裕年轻女性开始吸烟。
