Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom; Center for Population Health Sciences, Hanoi University of Public Health, no 1A Duc Thang street, North Tu Liem district, Hanoi 100000, Vietnam.
Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom.
Health Policy. 2023 Sep;135:104879. doi: 10.1016/j.healthpol.2023.104879. Epub 2023 Jul 9.
While smoking prevalence in high income countries has declined over time, socioeconomic inequalities in smoking have widened. This study is one of the few studies to examine the longitudinal pattern of income-related smoking inequalities and only the second using concentration indices in its analysis.
Income-related smoking inequalities were measured using concentration indices using the Northern Ireland Continuous Household Survey data. Smoking inequalities were compared quantitatively and visually across three periods: 1985-1995, 1997-2005 and 2007-2015. Joinpoint analysis was used to measure the overall time trend of smoking inequalities. Subgroup analysis was used to examine the nature of change in smoking inequalities across population sub-groups.
Throughout 1985-2015, smoking was more concentrated among the poor (standard concentration index of-0·131, p < 0·001). While prevalence declined sharply across population, income-related inequalities increased sharply in general and within subgroups. Income-related smoking inequalities were significantly larger among high educated group and those who were employed. No structural break was observed with respect to the adoption of any specific policy measures over the period.
Current approaches to tobacco control may be ill-suited to addressing smoking inequalities and may indeed be counterproductive. More tailored approaches that address the specific needs of population sub-groups or more draconian approaches such as extensions to prohibition may be required to reduce prevalence further while avoiding a widening of inequalities.
虽然高收入国家的吸烟率随着时间的推移而下降，但吸烟方面的社会经济不平等现象却在扩大。本研究是为数不多的研究吸烟相关不平等现象的纵向模式的研究之一，也是仅有的第二项使用集中指数进行分析的研究。
使用北爱尔兰连续家庭调查数据，使用集中指数衡量与收入相关的吸烟不平等现象。在三个时期（1985-1995 年、1997-2005 年和 2007-2015 年）对吸烟不平等现象进行了定量和直观的比较。使用 Joinpoint 分析来衡量吸烟不平等现象的总体时间趋势。亚组分析用于研究吸烟不平等现象在不同人口亚组中的变化性质。
在整个 1985-2015 年期间，吸烟现象在贫困人口中更为集中（标准集中指数为-0.131，p<0.001）。尽管人口中的吸烟率大幅下降，但总体而言，收入相关的不平等现象以及在各个亚组中都急剧增加。在高学历群体和就业人群中，与收入相关的吸烟不平等现象更为显著。在这一期间，没有观察到任何特定政策措施的采用存在结构上的突破。
目前的烟草控制方法可能不适合解决吸烟不平等问题，实际上可能适得其反。可能需要采取更有针对性的方法来满足特定人群的需求，或者采取更严厉的方法，如扩大禁令范围，以在避免不平等现象扩大的同时进一步降低吸烟率。
