Smoking related disease risk, deprivation and lifestyle behaviours Barbara Eberth (with D Olajide, A Ludbrook, P Craig, & D Stockton)

Motivation Smoking related diseases are an important source of preventable ill health and mortality Smoking related diseases affect all population groups, regardless of smoking status Smoking related disease risk is elevated by current or past tobacco smoke exposure, other lifestyle behaviours, and deprivation – ‘The causes of the causes’ (Marmot Review, 2010)

Objectives To model smoking related disease risk in the general population in Scotland To assess the contribution of deprivation to smoking related disease risk for the average individual in the population by smoking status To assess how this changes for the average individual by smoking status with – other healthy & unhealthy lifestyle behaviours – past experience of a smoking related disease

Data Administratively linked Scottish Morbidity records & Scottish Health Surveys (1995, 1998, 2003) Definition of smoking related disease incidence – ICD9 & ICD10 codes Analysis focus: – Risk of a smoking related disease incidence post survey Smoking status groups: – Never smokers – Never smokers exposed to Environmental tobacco smoke – Current smokers – Ex-smokers

Data Deprivation: – Scottish Index of Multiple Deprivation (SIMD) categorised into ordered quintiles SIMD51 – least deprived SIMD55 – most deprived Lifestyle behaviours: – Alcohol consumption Regular consumption within the recommended limit, regular consumption over the recommended limit, no or very occasional alcohol consumption – Diet BMI categories ( Underweight, normal weight, overweight, obese) – Physical activity Sports inactivity, light intensity sports, moderate intensity sports, vigorous intensity sports Other controls: – Gender, age, marital status, household composition, education, employment status, general health, medical history, health board

Descriptive Statistics

Descriptive statistics

Results

Conclusion Predicted risk of disease disproportionately concentrated amongst individuals from most deprived background regardless of smoking status group and highest for most deprived smokers – Implications for health inequalities Pre-existing smoking related disease incidence elevates the risk of future disease incidence substantially across the deprivation distribution – Target individuals with a pre-existing smoking related disease incidence/condition Healthy lifestyle behaviours are predicted to reduce smoking related disease risk across the deprivation distribution regardless of smoking status (gain smallest for smokers) – Smoking cessation in combination with changes in other lifestyle behaviours Unhealthy lifestyle behaviours predicted to increase smoking related disease risk across the deprivation distribution regardless of smoking status – Unhealthy lifestyle behaviours are bad for you → Healthy lifestyles are good for you – Substantial gains in predicted risks with adoption of healthy behaviours

Acknowledgements The receipt of the financial support from the MRC National Preventive Research Initiative Phase 2 grant G is acknowledged gratefully; see The Funding Partners relevant to this award are: – British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; and Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office, Scottish Government Health Directorates; The Stroke Association; Welsh Assembly Government and World Cancer Research Fund.