Relative and absolute socioeconomic inequality in smoking: time trends in Germany from 1995 to 2013

Purpose: This study aimed to investigate time trends in relative and absolute socioeconomic inequality in smoking prevalence in Germany using several indicators for socioeconomic position. Methods: We conducted a repeated cross-sectional study using representative samples of the German population aged between 25 and 64 years in 1995, 1999, 2005, 2009, and 2013 (n = 857,264). Socio-economic position was measured by indicators for income, education, and occupation. Relative and absolute socioeconomic inequalities were estimated with the regression-based relative index of inequality and the slope index of inequality, respectively. Trends in inequalities were estimated with interaction terms for time and relative index of inequality/slope index of inequality. Results: Highest and increasing smoking prevalence was observed among long-term unemployed and people with less than 60% of the median household income. Between 1995 and 2013, relative increases in inequalities in smoking prevalence ranged from 31% (95% confidence interval, 26%-36%; men, occupation) to 94% (95% confidence interval, 84%-104%; women, education). Absolute increases ranged from 6.2 (95% confidence interval, 4.7-7.6) percentage points (men, occupation) to 20.3 (95% confidence interval, 18.9-21.7) percentage points (women, education). Conclusions: Relative and absolute socioeconomic inequalities in smoking prevalence increased in Germany between 1995 and 2013, with regard to income, education, and occupation, particularly among women. (C) 2020 Elsevier Inc. All rights reserved.