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. 2019 Apr;73(4):334-339.
doi: 10.1136/jech-2018-211640. Epub 2019 Jan 23.

Contribution of smoking and alcohol consumption to income differences in life expectancy: evidence using Danish, Finnish, Norwegian and Swedish register data

Olof Östergren  1 , Pekka Martikainen  1   2   3 , Lasse Tarkiainen  2 , Jon Ivar Elstad  4 , Henrik Brønnum-Hansen  5
Affiliations

Contribution of smoking and alcohol consumption to income differences in life expectancy: evidence using Danish, Finnish, Norwegian and Swedish register data

Olof Östergren et al. J Epidemiol Community Health. 2019 Apr.

Abstract

Background: Despite being comparatively egalitarian welfare states, the Nordic countries have not been successful in reducing health inequalities. Previous studies have suggested that smoking and alcohol contribute to this pattern. Few studies have focused on variations in alcohol-related and smoking-related mortality within the Nordic countries. We assess the contribution of smoking and alcohol to differences in life expectancy between countries and between income quintiles within countries.

Methods: We collected data from registers in Denmark, Finland, Norway and Sweden comprising men and women aged 25-79 years during 1995-2007. Estimations of alcohol-related mortality were based on underlying and contributory causes of death on individual death certificates, and smoking-related mortality was based on an indirect method that used lung cancer mortality as an indicator for the population-level impact of smoking on mortality.

Results: About 40%-70% of the between-country differences in life expectancy in the Nordic countries can be attributed to smoking and alcohol. Alcohol-related and smoking-related mortality also made substantial contributions to income differences in life expectancy within countries. The magnitude of the contributions were about 30% in Norway, Sweden and among Finnish women to around 50% among Finnish men and in Denmark.

Conclusions: Smoking and alcohol consumption make substantial contributions to both between-country differences in mortality among the Nordic countries and within-country differences in mortality by income. The size of these contributions vary by country and sex.

Keywords: alcohol; mortality; registers; smoking; social inequalities.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Observed temporary life expectancy between 25 and 79 years and temporary life expectancy subtracting smoking-related and alcohol-related deaths in Sweden, Norway, Finland and Denmark, men and women, 1995–2007.
Figure 2
Figure 2
Observed temporary life expectancy and temporary life expectancy subtracting smoking-related and alcohol-related deaths in the top and bottom income quintiles, men and women in Denmark, Finland, Norway and Sweden, 25–79 years, 1995–2007.
See this image and copyright information in PMC

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