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OA04 - Epidemiology and Prevention of Lung Cancer (ID 370)
- Event: WCLC 2016
- Type: Oral Session
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 1
OA04.01 - Educational and Wealth Inequalities in Tobacco Use among Men and Women in 54 Low-And-Middle-Income Countries (ID 3910)
11:00 - 12:30 | Author(s): L. Ernstsen
To support health policies and place monitoring systems to tackle socio-economic inequalities in tobacco use in low-and-middle-income countries (LMIC) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in low-and-middle income countries.
We analyzed DHS data on tobacco use collected in 54 countries. We calculated weighted prevalence estimates of current tobacco use (any type of tobacco) in each country for five wealth groups and four educational groups. We calculated both absolute and relative measures of inequality, i.e., the Slope Index of Inequality (SII) and Relative Index of Inequality (RII), which take into account the distribution of prevalence across all wealth and education groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification.
Male tobacco use among was highest in Bangladesh (70.3%) lowest in Sao Tome (7.4%); whereas female tobacco use highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men educational inequalities varied widely between countries but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83-4.61) in LICs, 1.99 (95% CI 1.66-2.38) in lMIC, and 1.82 (95% CI 1.24-2.67) in uMIC. Wealth inequalities among men varied less between countries but both RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05-2.88) in LICs, 1.84 (95% CI 1.54-2.21) in lMICs, and 1.67 (95% CI 1.15-2.42) in uMIC. For educational inequalities among women, the RII varied much more than SII varied between the countries, and aggregate RII was 14.49 (95% CI 8.87-23.68) in LICs, 3.05 (95% CI 1.44-6.47) in lMIC and 1.58 (95% CI 0.33-7.56) in uMIC. Wealth inequalities among women showed a pattern similar to that of men: the RII was 5.88 (95% CI 3.91- 8.85) in LICs, 1.76 (95% CI 0.80 -3.85) in lMIC, and 0.39 (95% CI 0.09 -1.64) in uMIC. In contrast to men, among women the SII was pro-rich (higher smoking among the more advantaged) in 13 of the 52 countries (7 of 23 lMIC and 5 of 7 uMIC).
Our results confirm that socio-economic inequalities tobacco use exist in LMIC, varied widely between the countries, and were much wider in the lowest income countries. These findings are important for better understanding and tackling of socio-economic inequalities in health in LMIC.
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