Carlos de Mestral1,2, Steven Bell3, Emmanuel Stamatakis4,5, G David Batty1. 1. From the Research Department of Epidemiology and Public Health, University College London, London, United Kingdom. 2. Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. 3. Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. 4. Charles Perkins Centre, Epidemiology Unit, University of Sydney, Sydney, Australia. 5. School of Public Health, University of Sydney, Sydney, Australia.
Abstract
BACKGROUND: For the same quantity of cigarettes smoked, relative to more affluent people, socioeconomically disadvantaged people have higher levels of smoking biomarkers. This may be ascribed to inhaling cigarette smoke more deeply and more frequently and/or choosing higher tar-containing brands. We investigated whether this increased tobacco load, as captured using cotinine measurements, is associated with a greater risk of mortality in lower social groups. METHODS: We used Cox proportional hazards models stratified by socioeconomic position to calculate hazard ratios in a pooled sample of 15 English and Scottish prospective cohort studies (N = 81,476). RESULTS: During a mean (SD) follow-up of 10.3 (4.4) years, 8234 deaths occurred. Risk of total mortality (hazard ratio; 95% confidence interval) for smokers relative to never-smokers in the high (2.5; 2.1, 3.1), intermediate (2.1; 1.8, 2.4), and low (2.0; 1.9, 2.2) educational groups did not differ markedly (P for interaction=0.61). Similar findings emerged when using cause-specific outcomes and occupational social class and housing tenure as socioeconomic indices. CONCLUSION: Contrary to our hypothesis, we found no indication that chronic disease mortality associated with smoking was higher in disadvantaged people.
BACKGROUND: For the same quantity of cigarettes smoked, relative to more affluent people, socioeconomically disadvantaged people have higher levels of smoking biomarkers. This may be ascribed to inhaling cigarette smoke more deeply and more frequently and/or choosing higher tar-containing brands. We investigated whether this increased tobacco load, as captured using cotinine measurements, is associated with a greater risk of mortality in lower social groups. METHODS: We used Cox proportional hazards models stratified by socioeconomic position to calculate hazard ratios in a pooled sample of 15 English and Scottish prospective cohort studies (N = 81,476). RESULTS: During a mean (SD) follow-up of 10.3 (4.4) years, 8234 deaths occurred. Risk of total mortality (hazard ratio; 95% confidence interval) for smokers relative to never-smokers in the high (2.5; 2.1, 3.1), intermediate (2.1; 1.8, 2.4), and low (2.0; 1.9, 2.2) educational groups did not differ markedly (P for interaction=0.61). Similar findings emerged when using cause-specific outcomes and occupational social class and housing tenure as socioeconomic indices. CONCLUSION: Contrary to our hypothesis, we found no indication that chronic disease mortality associated with smoking was higher in disadvantaged people.
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