Contribution of lifetime smoking habit in France and Northern Ireland to country and socioeconomic differentials in mortality and cardiovascular incidence: the PRIME Study

• Published in: Journal of epidemiology and community health (1979) 2012-07, Vol.66 (7), p.599-604
• Main Authors: Yarnell, J W G, Patterson, C C, Arveiler, D, Amouyel, P, Ferrières, J, Woodside, J V, Haas, B, Montaye, M, Ruidavets, J B, Kee, F, Evans, A, Bingham, A, Ducimetière, P
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - mortality; Cigarette smoking; Cigarettes; Coronary artery disease; Disease models; Exercise; Follow-Up Studies; France - epidemiology; Fruits; General aspects; Habitual behavior; health behaviour; heart disease; Home ownership; Humans; Laboratories; Lifestyle; lifetime smoking; longitudinal studies; Male; Medical sciences; Middle Aged; Miscellaneous; Mortality; Mortality - trends; Northern Ireland - epidemiology; Predisposing factors; prospective study; Public health. Hygiene; Public health. Hygiene-occupational medicine; Questionnaires; Recruitment; Risk factors; Smoking; Smoking - epidemiology; smoking RB; Social and psychosocial factors and health; Social Class; social factors; Socioeconomic factors; Socioeconomics; Stroke; Study habits; Surveys and Questionnaires; Tobacco Use Disorder; Tobacco, tobacco smoking; Toxicology
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.2010.123943

BackgroundThis study examines the contribution of lifetime smoking habit to the socioeconomic gradient in all-cause and smoking-related mortality and in cardiovascular incidence in two countries.Methods10 600 men aged 50–59 years were examined in 1991–4 in centres in Northern Ireland and France and followed annually for 10 years. Deaths and cardiovascular events were documented. Current smoking habit, lifetime smoking (pack-years) and other health behaviours were evaluated at baseline. As socio-occupational coding schemes differ between the countries seven proxy socioeconomic indicators were used.ResultsLifetime smoking habit showed marked associations with most socioeconomic indicators in both countries, but lifetime smoking was more than 10 pack-years greater overall in Northern Ireland and smoking patterns differed. Total mortality was 49% higher in Northern Ireland than in France, and smoking-related mortality and cardiovascular incidence were 93% and 92% higher, respectively. Both lifetime smoking and fibrinogen contributed independently to these differentials, but together explained only 42% of the difference in total mortality between countries, adjusted for both biological and lifestyle confounders. Socioeconomic gradients were steeper for total and smoking-related mortality than for cardiovascular incidence. Residual contributions of lifetime smoking habit ranged from 6% to 34% for the seven proxy indicators of socioeconomic position for total and smoking-related mortality. Socioeconomic gradients in cardiovascular incidence were minimal following adjustment for confounders.ConclusionIn Northern Ireland and France lifetime smoking appeared to explain a significant part of the gradients in total and smoking-related mortality between socioeconomic groups, but the contribution of smoking was generally small for cardiovascular incidence.