Smoking and inequalities.

摘要

Smoking is a modern scourge. The WHO global burden of disease study suggested that, in developed countries, 26% of male deaths and 9% of female deaths could be attributed to smoking-the single most important risk factor. We must consider not just aggregate effects but social distribution. In many countries the likelihood of smoking is linked to socioeconomic position: lower status, more smoking. Hence, among other evils, smoking contributes to social inequalities in mortality. The size of that contribution is considerable. In today's Lancet, Prabhat Jha and colleagues2 estimate that at least half of socioeconomic differences in mortality in men aged 35-69 years can be laid at the foot of smoking.An estimate of more than half of social differentials caused by smoking is larger than previous estimates. In the Whitehall study of British civil servants, a combination of smoking and other coronary risk factors accounted for 27% of the inverse social gradient in mortality from coronary heart disease.The British Regional Heart Study reached a similar conclusion: 24% of the higher ail-cause mortality in manual compared with non-manual workers could be attributed to smoking.To put it differently: in the Whitehall II study, in which fewer than 20% of people smoked, there was still a clear social gradient in disease in people who had never smoked.