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Changing smoking-mortality association over time and across social groups: National census-mortality cohort studies from 1981 to 2011.

ABSTRACT: The difference in mortality between current and never-smokers varies over time, affecting future projections of health gains from tobacco control. We examine this heterogeneity by sex, ethnicity and cause of death on absolute and relative scales using New Zealand census data. These data included smoking status, and were linked to subsequent mortality records in 1981-84, 1996-99 and 2006-11 for 25-74 year olds (16.1 million person-years of follow-up). Age-standardised mortality rates and rate differences (SRDs) were calculated comparing current to never-smokers, and Poisson regression was used to adjust for multiple socioeconomic factors and household smoking. We found that mortality declined over time in never-smokers; however, mortality trends in current-smokers varied by sex, ethnicity and cause of death. SRDs were stable over time in European/Other men, moderately widened in European/Other women and markedly increased in M?ori men and women (Indigenous population). Poisson smoking-mortality rate ratios (RRs) increased from 1981-84 to 1996-99 with a moderate increase from 1996-99 to 2006-11 (RRs 1.48, 1.77, 1.79 in men and 1.51, 1.80, 1.90 in women). Socioeconomic confounding increased over time. In summary, this marked heterogeneity in smoking-mortality RRs over time has implications for estimating the future health and inequality impacts of tobacco control interventions.

SUBMITTER: Teng A

PROVIDER: S-EPMC5597615 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Changing smoking-mortality association over time and across social groups: National census-mortality cohort studies from 1981 to 2011.

Teng Andrea A Atkinson June J Disney George G Wilson Nick N Blakely Tony T

Scientific reports 20170913 1

The difference in mortality between current and never-smokers varies over time, affecting future projections of health gains from tobacco control. We examine this heterogeneity by sex, ethnicity and cause of death on absolute and relative scales using New Zealand census data. These data included smoking status, and were linked to subsequent mortality records in 1981-84, 1996-99 and 2006-11 for 25-74 year olds (16.1 million person-years of follow-up). Age-standardised mortality rates and rate dif ...[more]

PMID: 28904367

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Project description:BackgroundDetailed assessments of mortality by occupation are scarce. We aimed to assess mortality by occupation in the UK, differences in rates between England and Wales and Scotland, and changes over time in Scotland.MethodsWe analysed adults of working age (20-59 years) using linked census and death records. Main occupation was coded into more than 60 groups in the 2001 census, with mortality follow-up until Dec 31, 2011. Comparable occupation data were available for Scotland in 1991, allowing assessment of trends over time. We calculated age-standardised all-cause mortality rates (per 100 000 person-years), stratified by sex. We used Monte Carlo simulation to derive p values and 95% CIs for the difference in mortality over time and between England and Wales and Scotland.FindingsDuring 4·51 million person-years of follow-up, mortality rates by occupation differed by more than three times between the lowest and highest observed rates in both men and women. Among men in England and Wales, health professionals had the lowest mortality (225 deaths per 100 000 person-years [95% CI 145-304]), with low rates also shown in managers and teachers. The highest mortality rates were in elementary construction (701 deaths per 100 000 person-years [95% CI 593-809]), and housekeeping and factory workers. Among women, teachers and business professionals had low mortality, and factory workers and garment trade workers had high rates. Mortality rates have generally fallen, but have stagnated or even increased among women in some occupations, such as cleaners (337 deaths per 100 000 person years [95% CI 292-382] in 1991, rising to 426 deaths per 100 000 person years in 2001 [371-481]). Findings from simulation models suggested that if mortality rates by occupation in England and Wales applied to Scotland, 631 fewer men (95% CI 285-979; a 9·7% decrease) and 273 fewer women (26-513; 6·7% decrease) of working age would die in Scotland every year. Excess deaths in Scotland were concentrated among lower skilled occupations (eg, female cleaners).InterpretationMortality rates differ greatly by occupation. The excess mortality in Scotland is concentrated among low-skilled workers and, although mortality has improved in men and women in most occupational groups, some groups have experienced increased rates. Future research investigating the specific causes of death at the detailed occupational level will be valuable, particularly with a view to understanding the health implications of precarious employment and the need to improve working conditions in very specific occupational groups.FundingNone.

Dataset Information

Changing smoking-mortality association over time and across social groups: National census-mortality cohort studies from 1981 to 2011.

Publications

Changing smoking-mortality association over time and across social groups: National census-mortality cohort studies from 1981 to 2011.

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