TY - JOUR

T1 - What is the association of smoking and alcohol use with the increase in social inequality in mortality in Denmark?

T2 - A nationwide register-based study

AU - Koch, Mette Bjerrum

AU - Diderichsen, Finn

AU - Grønbæk, Morten

AU - Juel, Knud

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015/5/11

Y1 - 2015/5/11

N2 - OBJECTIVES: The aim of this paper is to estimate the impact of smoking and alcohol use on the increase in social inequality in mortality in Denmark in the period 1985-2009.DESIGN: A nationwide register-based study.SETTING: Denmark.PARTICIPANTS: The whole Danish population aged 30 years or more in the period 1985-2009.PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is mortality rates in relation to educational attainments calculated with and without deaths related to smoking and alcohol use. An absolute measure of inequality in mortality is applied along with a result on the direct contribution from smoking and alcohol use on the absolute difference in mortality rates. The secondary outcome is life expectancy in relation to educational attainments.RESULTS: Since 1985, Danish overall mortality rates have decreased. Alongside the improvement in mortality, the absolute difference in the mortality rate (per 100 000 persons) between the lowest and the highest educated quartile grew from 465 to 611 among men and from 250 to 386 among women. Smoking and alcohol use have caused 75% of the increase among men and 97% of the increase among women. Among men the increase was mainly caused by alcohol. In women the increase was mainly caused by smoking.CONCLUSIONS: The main explanation for the increase in social inequality in mortality since the mid-1980s is smoking and alcohol use. A significant reduction in the social inequality in mortality can only happen if the prevention of smoking and alcohol use are targeted to the lower educated part of the Danish population.

AB - OBJECTIVES: The aim of this paper is to estimate the impact of smoking and alcohol use on the increase in social inequality in mortality in Denmark in the period 1985-2009.DESIGN: A nationwide register-based study.SETTING: Denmark.PARTICIPANTS: The whole Danish population aged 30 years or more in the period 1985-2009.PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is mortality rates in relation to educational attainments calculated with and without deaths related to smoking and alcohol use. An absolute measure of inequality in mortality is applied along with a result on the direct contribution from smoking and alcohol use on the absolute difference in mortality rates. The secondary outcome is life expectancy in relation to educational attainments.RESULTS: Since 1985, Danish overall mortality rates have decreased. Alongside the improvement in mortality, the absolute difference in the mortality rate (per 100 000 persons) between the lowest and the highest educated quartile grew from 465 to 611 among men and from 250 to 386 among women. Smoking and alcohol use have caused 75% of the increase among men and 97% of the increase among women. Among men the increase was mainly caused by alcohol. In women the increase was mainly caused by smoking.CONCLUSIONS: The main explanation for the increase in social inequality in mortality since the mid-1980s is smoking and alcohol use. A significant reduction in the social inequality in mortality can only happen if the prevention of smoking and alcohol use are targeted to the lower educated part of the Danish population.

U2 - 10.1136/bmjopen-2014-006588

DO - 10.1136/bmjopen-2014-006588

M3 - Journal article

C2 - 25967987

VL - 5

SP - 1

EP - 9

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 5

M1 - e006588

ER -