Magnitud y evolución de las desigualdades sociales en el tabaquismo en la comunidad autónoma de Euskadi: 1986-2007

Abstract

Introduction and objective In southern European countries, the smoking epidemic is still evolving and it shows differences according to sex and age. Scarce studies have analyzed social inequalities in smoking in a long period of 21 years, considering initiation and cessation dynamics as well as second-hand smoke exposure in a comprehensive way in the South of Europe. Moreover, no studies have been found which use the electronic medical record of Primary Healthcare to analyze the social inequalities in smoking cessation programmes in Spain. The objective of this thesis is to analyze the evolution of the smoking epidemic in the Basque Country, according to social class, educational level and a socioeconomic deprivation index from 1986 to 2007, by sex and age groups. Methods This was a cross-sectional time trend study on the population aged >16 years using the Basque Country Health Surveys of 1986, 1992, 1997, 2002 and 2007. For the analysis of inequalities in the participation in cessation programs, a cross-sectional study on the population aged >16 belonging to any health centre of Araba was done. In this case, socioeconomic information of census tracks was used to obtain the MEDEA deprivation index. Age-adjusted prevalences and means were calculated according to social class and educational level, and for the participation in cessation programmes according to the MEDEA deprivation index. To summarize the magnitude of inequalities, the relative index of inequality was calculated as well as the population attributable risk. Age-adjusted means and summary of inequalities was done by means of covariance analysis. Survival curves were calculated and the relative risks of starting smoking were estimated using Cox´s proportional hazard regression models. Calculations were performed separately by sex and for two age groups (25-44 and >44). Results Basque males have diminished their smoking prevalence while women show a stabilized prevalence during the last years. Young population has evolved towards the last stage of the epidemic, with an increasing concentration of smoking in disadvantaged groups. In young women and old men, a change has been observed along the period towards a more frequent smoking among the most disadvantaged groups. The role of initiation and cessation inequalities as determinants of smoking inequalities differed considerably by age and sex. Anti-smoking advice was more frequent among more disadvantaged young population and cessation programmes among more disadvantaged men. Inequalities in second-hand smoke exposure differed by place, and also by age and sex. Conclusions Inequalities in smoking are relevant and have widened from 1986 to 2007 in the Basque Country, especially among the youngest population. The changing pattern of these inequalities, the emergence of new persistent smoker profiles, and the different roles of initiation and cessation dynamics need to be taken into account to improve the results of tobacco control policies and their effect on smoking inequalities.

Date of Award	13 Jul 2012
Original language	Spanish
Supervisor	Carme Borrell Thió (Director) & Miquel Porta Serra (Tutor)