Smoking related disease risk, deprivation and lifestyle behaviours

1. Smoking related disease risk, deprivation and lifestyle behaviours Barbara Eberth b.eberth@abdn.ac.uk (with D Olajide, A Ludbrook, P Craig, & D Stockton)

2. 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)

3. 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

4. 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

5. 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

6. Descriptive Statistics

7. Descriptive statistics

8. Results

9. Results

10. Results

11. Results

12. 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

13. Acknowledgements • The receipt of the financial support from the MRC National Preventive Research Initiative Phase 2 grant G0701874 is acknowledged gratefully; see http://www.npri.org.uk • 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.