lower social class, income or education have twice the
risk of dying during middle age compared with their
counterparts with higher socioeconomic status, new study
findings show. Up to about half of the excess deaths may
be due to smoking, based on extrapolation of data
regarding lung cancer rates in different countries.
To discern the origin of the increased death risk among
men ages 35 to 69 of lower socioeconomic status,
Dr. Prabhat Jha, from the University
of Toronto, and colleagues analyzed data from four
countries for 1996. Their findings appear in The Lancet.
They determined the top and bottom social strata based on
occupation (professional versus unskilled manual labor) in
England and Wales, neighborhood income in Canada, and
years of education in the US and Poland. The investigators
then estimated the death risk attributable to smoking
based on age-specific lung cancer rates and other diseases
associated with smoking, among about 564,000 men.
As noted, the death rate was twice as high among men in
the lower strata versus those in the highest. The
proportion of deaths caused by smoking ranged from 38
percent in Canada to 45 percent in Poland. Jha's group
notes, "a substantial increase in
smoking cessation could approximately halve these 1996
social inequalities in adult male" deaths.
In a related commentary, Dr. Michael Marmot from
University College London writes: "Social gradient in
(death risk) is the result of differences in the social
circumstances in which people live and work."
He cautions that the adverse effects of "social
conditions, neighborhood deprivation, employment
conditions, early childhood and subsequent adult disease"
should not be forgotten in efforts to reduce smoking