Smoking kills -- irrespective of social class and gender

February 17, 2009

A well-off professional who smokes has a much lower survival rate than a non-smoking low-paid worker of the same sex concludes new research published today on bmj.com.

The study, one of the first to examine the long-term impact of smoking on older men and women, 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. Surprisingly, 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. As the authors say "in essence, neither affluence nor being female offers a defence against the toxicity of tobacco."

Dr Laurence Gruer and Dr David Gordon from NHS Health Scotland and Professor Graham Watt and Dr Carole Hart from the University of Glasgow 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 grouped by gender and social class and further 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 after 14 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). Smokers in the lowest social classes fared even worse.

On a positive note, the study found that the death rates of ex-smokers were much closer to those of never-smokers than smokers, showing that quitting does make a difference regardless of social position.

Dr Gruer, Director of Public Health Science at NHS Health Scotland, said: "This study reinforces current policies in the United Kingdom and other countries aimed at helping smokers stop smoking. Accessible and effective smoking cessation advice and services, as well as strong action to discourage young people from starting to smoke, are key to reducing health inequalities. With over 23% of adults in the UK still smoking, rising to well over 40% in some places and groups, it's crucial we continue to make smoking cessation a top priority."

Source: British Medical Journal