Inequalities in smoking and obesity in Europe predicted to 2050: Findings from the EConDA project

Abstract

Aims: The aim of this study was to project educational inequalities in obesity and smoking prevalence to 2050 based on past obesity and smoking trends by education level. Methods: Data on obesity (body mass index ≥ 30) and smoking prevalence (current smokers) by education level (tertiary education and less than tertiary) from nationally representative cross-sectional surveys were collected for the following six countries participating in the Economics of Chronic Diseases project (EConDA): England, Finland, Lithuania, the Netherlands, Poland (obesity only) and Portugal (obesity only). A nonlinear multivariate regression model was fitted to the data to create longitudinal projections to 2050. Inequalities were measured with a prevalence ratio and a prevalence difference using projected obesity/smoking prevalence. Results: Educational inequalities in obesity prevalence are projected to increase in Finland, Lithuania and England for men, and in Lithuania and Poland for women, by 2050. Obesity prevalence is projected to increase faster among the more advantaged groups in England, Portugal, Finland and the Netherlands among women, and Portugal and the Netherlands among men, narrowing inequalities. In contrast to obesity, smoking prevalence is projected to continue declining in most of the countries studied. The decline is projected to be faster in relative terms among more advantaged groups; therefore, relative educational inequalities in smoking prevalence are projected to increase in all countries. Conclusions: Widening educational inequalities in obesity and smoking prevalence are expected in several European countries if current trends in obesity and smoking prevalence are unaltered. This will impact on inequalities in morbidity and mortality of associated diseases such as diabetes, coronary heart disease and chronic obstructive pulmonary disease.

Keywords

Obesity smoking health inequalities trends England Poland Finland Portugal Lithuania the Netherlands

Get full access to this article

View all access options for this article.

References

Murray

Barber

Foreman

et al . Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet 2015;386:2145–91.

Finucane

Stevens

Cowan

et al . National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011;377:557–67.

NCD Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016;387:1377–96.

Bilano

Gilmour

Moffiet

et al . Global trends and projections for tobacco use, 1990–2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control. Lancet 2015;385:966–76.

Sassi

. Obesity and the economics of prevention: fit not fat. Paris: OECD Publishing, 2010.

Gallo

Mackenbach

Ezzati

et al . Social inequalities and mortality in Europe–results from a large multi-national cohort. PLoS One 2012;7:e39013.

Mackenbach

Stirbu

Roskam

et al . Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008;358:2468–81.

Huisman

Kunst

Mackenbach

JP.

Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control 2005;14:106–13.

Popkin

Gordon-Larsen

The nutrition transition: worldwide obesity dynamics and their determinants. Int J Obes Relat Metab Disord 2004;28(Suppl 3):S2–9.

10.

Molarius

Seidell

Sans

et al . Educational level, relative body weight, and changes in their association over 10 years: an international perspective from the WHO MONICA Project. Am J Public Health 2000;90:1260–8.

11.

Zhang

Wang

Trends in the association between obesity and socioeconomic status in U.S. adults: 1971 to 2000. Obes Res 2004;12:1622–32.

12.

Mackenbach

Kunst

AE.

Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med 1997;44:757–71.

13.

McLaren

Socioeconomic status and obesity. Epidemiol Rev 2007;29:29–48.

14.

Friel

Chopra

Satcher

Unequal weight: equity oriented policy responses to the global obesity epidemic. BMJ 2007;335:1241–3.

15.

Monteiro

Moura

Conde

et al . Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ 2004;82:940–6.

16.

Kriaucioniene

Klumbiene

Petkeviciene

et al . Time trends in social differences in nutrition habits of a Lithuanian population: 1994–2010. BMC Public Health 2012;12:218.

17.

Perez-Ferrer

McMunn

A Rivera

Dommarco

et al . Educational inequalities in obesity among Mexican women: time-trends from 1988 to 2012. PLoS One 2014;9:e90195.

18.

World Health Organisation. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organisation, 2013.

19.

Backholer

Beauchamp

Ball

et al . A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight. Am J Public Health 2014;104:e43–50.

20.

Giskes

Kunst

Benach

et al . Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. J Epidemiol Community Health 2005;59:395–401.

21.

Layte

Whelan

CT.

Explaining social class inequalities in smoking: the role of education, self-efficacy, and deprivation. Eur Sociol Rev 2009;25:399–410.

22.

Pampel

FC.

Diffusion, cohort change, and social patterns of smoking. Soc Sci Res 2005;34:117–39.

23.

Galobardes

Shaw

Lawlor

et al . Indicators of socioeconomic position (part 1). J Epidemiol Community Health 2006;60:7–12.

24.

Morrison

Marx, Durkheim, Weber: formations of modern social thought. London: SAGE, 1995.

25.

Shiely

Hayes

Perry

et al . Height and weight bias: the influence of time. PLoS One 2013;8:e54386.

26.

Niedhammer

Bugel

Bonenfant

et al . Validity of self-reported weight and height in the French GAZEL cohort. Int J Obes Relat Metab Disord 2000;24:1111–18.

27.

Patrick

Cheadle

Thompson

et al . The validity of self-reported smoking: a review and meta-analysis. Am J Public Health 1994;84:1086–93.

28.

Wagenknecht

Burke

Perkins

et al . Misclassification of smoking status in the CARDIA study: a comparison of self-report with serum cotinine levels. Am J Public Health 1992;82:33–6.

29.

Shaw

Galobardes

Lawlor

et al . The handbook of inequality and socioeconomic position. Bristol: Policy Press, 2007.

30.

Index Mundi. Age distribution by country, http://www.indexmundi.com/facts/visualizations/age-distribution/ (2016, accessed 24 October 2017).

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

0.17 MB

3.17 MB

2.12 MB

0.02 MB