Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America

Background There are substantial social inequalities in adult male mortality in many countries. Smoking is often more prevalent among men of lower social class, education, or income. The contribution of smoking to these social inequalities in mortality remains uncertain. Methods The contribution of smoking to adult mortality in a population can be estimated indirectly from disease-specific death rates in that population (using absolute lung cancer rates to indicate proportions due to smoking of mortality from certain other diseases). We applied these methods to 1996 death rates at ages 35-69 years in men in three different social strata in four countries, based on a total of 0.6 million deaths. The highest and lowest social strata were based on social class (professional vs unskilled manual) in England and Wales, neighbourhood income (top vs bottom quintile) in urban Canada, and completed years of education (more than vs less than 12 years) in the USA and Poland. Results In each country, there was about a two-fold difference between the highest and the lowest social strata in overall risks of dying among men aged 35-69 years (England and Wales 21% vs 43%, USA 20% vs 37%, Canada 21% vs 34%, Poland 26% vs 50%: four-country mean 22% vs 41%, four-country mean absolute difference 19%). More than half of this difference in mortality between the top and bottom social strata involved differences in risks of being killed at age 35-69 years by smoking (England and Wales 4% vs 19%, USA 4% vs 15%, Canada 6% vs 13%, Poland 5% vs 22%: four-country mean 5% vs 17%, four-country mean absolute difference 12%). Smoking-attributed mortality accounted for nearly half of total male mortality in the lowest social stratum of each country. Conclusion In these populations, most, but not all, of the substantial social inequalities in adult male mortality during the 1990s were due to the effects of smoking. Widespread cessation of smoking could eventually halve the absolute differences between these social strata in the risk of premature death.

Timber shutters, Ocean View Farmhouse, Mount Mee

Timber shutters to the living room seating alcove, in the open position.

View along North-East elevation, Ocean View Farmhouse, Mount Mee

As seen from timber entrance ramp.

North-East and North-West elevations of Ocean View Farmhouse model, Mount Mee

Cardboard the balsa model as seen from above.

Aerial view of Ocean View Farmhouse model, Mount Mee

Cardboard and balsa model as seen from above.

Living room seating alcove, Ocean View Farmhouse, Mount Mee

View of seating alcove from living room with timber shutters in the closed position.

Main deck, Ocean View Farmhouse, Mount Mee

View across main deck to farm beyond.

Living room seating alcove, Ocean View Farmhouse, Mount Mee

View to seating alcove from living room with the timber shutters in the open position.

Hand-drawn plan, Ocean View Farmhouse, Mount Mee

Plan drawing.

Leadlight windows, Ocean View Farmhouse, Mount Mee

Detailed view of leadlight windows as seen from dining room.