A well-off professional  who smokes has a much lower survival rate than a non-smoking manual worker of the same sex, new research reveals.

The study, one of the first to examine the long-term impact of smoking on older men and women, was carried out by the University of Glasgow’s Department of Public Health and NHS Health Scotland.

Published by the BMJ, it shows that smoking itself is a greater source of health inequalities than social position. Among both men and  women, smokers of all social classes had a much higher risk of premature death than non-smokers from even the lowest social classes. Contrary to popular belief, non-smoking women in the lowest social classes had one of the lowest death rates.

The research also found that the survival advantage that women normally have over men is cancelled out by smoking.  The first author, Dr Laurence Gruer, Director of Public Health Science with NHS Health Scotland, says “in essence, neither affluence nor being female offers a defence against the toxicity of tobacco.”

Gruer and the research team, which included Professor Graham Watt and Dr Carole Hart, studied the impact of smoking on the survival rates of 15,000 men and women recruited in 1972-76 from Renfrew and Paisley in the West of Scotland.  The participants were assessed by gender, occupation and social class and were divided into smokers, never-smokers and ex-smokers.  The social class category was sub-divided as I and II (highest); III non manual; III manual; and IV and V (lowest).

Death rates for the participants were assessed after14 years and 28 years.  The results show that, during both follow-up periods, smokers had much higher death rates than never-smokers among both women and men and in every social class.
After 28 years of follow-up, 56% of female never-smokers and 36% of male never-smokers in the lowest social classes (IV and V) were still alive compared with only 41% of female smokers and 24% of male smokers in the top two social class groups (I and II).

On a positive note, Gruer’s research shows that the death rates of ex-smokers were closer to those of never-smokers than smokers, leading the authors to argue that “this study reinforces the logic of current action in the United Kingdom and other countries to encourage and enable smokers to stop smoking.”

The authors conclude that unless many smokers in lower social positions can stop smoking “the scope for reducing health inequalities in this and similar populations is limited.”  They add: “As over 23% of adults in the United Kingdom still smoke, rising to over 40% in some areas, continued concerted efforts will be required to reduce the burden of smoking related illness and premature death.  If this is not done, health inequalities related to social position can only widen.”

For more information, contact Ray McHugh in the University of Glasgow Media Relations Office on 0141 330 3535 or email r.mchugh@admin.gla.ac.uk

First published: 18 February 2009

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