Smoking's impact on mortality in Europe

En Europe, l’épidémie de tabac a influé sur les niveaux et tendances de la mortalité, ainsi que sur les différences entre les sexes et entre les pays. En 2014, le tabac réduit l’espérance de vie des hommes de 2,7 ans en moyenne et celle des femmes de 1,0 an. Le tabac explique 28 % de l’écart d’espérance de vie entre les sexes. L’épidémie de tabac est la plus avancée dans le Nord-Ouest de l’Europe. L’effet du tabac y est en recul chez les hommes, mais n’a pas encore atteint son pic chez les femmes, et leurs mortalités dues au tabac sont proches. Sans le tabac, l’espérance de vie n’aurait pas stagné dans des pays comme le Danemark et les Pays-Bas chez les hommes dans les années 1950-1960, et chez les femmes dans les années 1980-1990. Elle aurait augmenté en général de façon plus importante, et les évolutions des hommes et des femmes auraient été plus proches

The role of smoking in country differences in life expectancy across Europe, 1985-2014

INTRODUCTION: Smoking contributes substantially to mortality levels and trends. Its role in country differences in mortality has, however, hardly been quantified. The current study formally assesses the - so far unknown - changing contribution of smoking to country differences in life expectancy at birth (e0) across Europe. METHODS: Using all-cause mortality data and indirectly estimated smoking-attributable mortality rates by age and sex for 30 European countries from 1985 to 2014, the differences in e0 between each individual European country and the weighted average were decomposed into a smoking- and a non-smoking-related part. RESULTS: In 2014, e0 ranged from 70.8 years in Russia to 83.1 years in Switzerland. Men exhibited larger country differences than women (variance of 21.9 and 7.0 years, respectively). Country differences in e0 increased up to 2005, and declined thereafter. Among men, the average contribution of smoking to the country differences in e0 was highest around 1990 (47%), and declined to 35% in 2014. Among women, the average relative contribution of smoking declined from 1991 to 2011, and smoking resulted in smaller differences in the average e0 level in the majority of European countries. For both sexes combined, the contribution of smoking to country differences in e0 was higher than 20% throughout the period. CONCLUSIONS: Smoking contributed substantially to the country differences in e0 in Europe, their increases up to 1991, and their decreases since 2005, especially among men. Policies that discourage smoking can help to reduce inequalities in mortality levels across Europe in the long run

Changing contribution of smoking to the sex differences in life expectancy in Europe, 1950-2014

This article provides a detailed and overarching illustration of the contribution of smoking to sex differences in life expectancy at birth (e0) in Europe, focusing on changes over time and differences between both European countries and European regions. For this purpose, the sex difference in e0 for 31 European countries over the 1950-2014 period was decomposed into a smoking- and a non-smoking-related part, using all-cause mortality data and indirectly estimated smoking-attributable mortality rates by age and sex, and a formal decomposition analysis. It was found that smoking-attributable mortality contributed, on average, 3 years (43.5%) to the 7-year life expectancy difference between women and men in 2014. This contribution, was largest in 1995, at 5.2 out of 9.0 years, and subsequently declined in parallel with the average sex difference in life expectancy. The average contribution of smoking-attributable mortality was especially large in North-Western Europe around 1975; in Southern Europe around 1985; and in Eastern Europe around 1990-1995, when smoking-attributable mortality reached maximum levels among men, but was still low among women. The observed parallel decline from 1995 onwards in the sex differences in e0 and the absolute contribution of smoking to this sex difference suggests that this recent decline in the sex difference in e0 can be almost fully explained by historical changes in sex differences in smoking, and, consequently, smoking-attributable mortality. In line with the progression of the smoking epidemic, the sex differences in life expectancy in Europe are expected to further decline in the future