Looking at the smoking epidemic through the lens of population pyramids: sociodemographic patterns of smoking in Italy,
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RESEARCH
Open Access
Looking at the smoking epidemic through the lens of population pyramids: sociodemographic patterns of smoking in Italy, 1983 to 2005 Bruno Federico1,2*, Giovanni Capelli1, Giuseppe Costa3, Johan P Mackenbach2 and Anton E Kunst4
Abstract Background: Surveillance systems often present data by means of summary measures, like age-standardised rates. In this study, we aimed at comparing information derived from commonly used measures of smoking with that presented in modified population pyramids (PPs), using the example of the diffusion of smoking in Italy over the past two decades. Methods: Data were derived from four National Health Interview Surveys carried out in 1983, 1990 to 1991, 1999 to 2000, and 2004 to 2005. After computing both age-specific and age-standardised rates of current, former, and never smoking, we constructed modified PPs by stratifying the male and female populations according to smoking status and educational level. Results: Modified PPs showed several features of the smoking epidemic in Italy that were not apparent from conventional surveillance techniques. First, they showed that the population of smokers is aging, with most current smokers in 2005 being males aged 25 to 39 and females aged 40 to 49, whereas in 1983 most smokers belonged to the youngest age groups. Second, they showed that in 2005 most smokers were found among subjects with middle and higher education, whereas two decades earlier most smokers were (male) subjects with the lowest education. Conclusions: Modified PPs were able to show how absolute numbers of smokers were distributed by age and sex, how these numbers varied between population subgroups, and how they changed over time. PPs may help provide information on past and future trends in the absolute number of smokers and in their sociodemographic characteristics, which may be missed using only traditional surveillance methods. Keywords: Smoking, Education, Time trends, Surveillance, Population pyramids
Background Tobacco smoking largely contributes to premature death and disease in developed countries [1]. It is estimated that tobacco caused about 5 million deaths in 2005, and the yearly death toll of smoking is expected to increase over the next 20 years [2]. This increase is a consequence of the diffusion that smoking had in the previous decades, because of the considerable time delay before smoking-related mortality rises [3]. * Correspondence: [email protected] 1 Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy 2 Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands Full list of author information is available at the end of the article
In the UK, smoking reached its peak among men in the 1940s and among women two decades later [4]. A similar pattern was observed in the US and Northern Europe while southern European countries lagged behind in the progression of the epidemic [5-8]. Subjects at the top of the social hierarchy were the first to take up the habit of
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