Socioeconomic differentials in the immediate mortality effects of the national Irish smoking ban

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dc.contributor.author Stallings-Smith, Sericea
dc.contributor.author Goodman, Pat
dc.contributor.author Kabir, Zubair
dc.contributor.author Clancy, Luke
dc.contributor.author Zeka, Ariana
dc.date.accessioned 2016-02-17T11:44:40Z
dc.date.available 2016-02-17T11:44:40Z
dc.date.issued 2014
dc.identifier.citation Stallings-Smith S, Goodman P, Kabir Z, Clancy L, Zeka A (2014) Socioeconomic Differentials in the Immediate Mortality Effects of the National Irish Smoking Ban. PLoS ONE 9(6): e98617. doi:10.1371/journal.pone.0098617
dc.identifier.volume 9 en
dc.identifier.issued 6 en
dc.identifier.issn 1932-6203
dc.identifier.uri http://hdl.handle.net/10468/2337
dc.identifier.doi 10.1371/journal.pone.0098617
dc.description.abstract Background: Consistent evidence has demonstrated that smoking ban policies save lives, but impacts on health inequalities are uncertain as few studies have assessed post-ban effects by socioeconomic status (SES) and findings have been inconsistent. The aim of this study was to assess the effects of the national Irish smoking ban on ischemic heart disease (IHD), stroke, and chronic obstructive pulmonary disease (COPD) mortality by discrete and composite SES indicators to determine impacts on inequalities. Methods: Census data were used to assign frequencies of structural and material SES indicators to 34 local authorities across Ireland with a 2000-2010 study period. Discrete indicators were jointly analysed through principal component analysis to generate a composite index, with sensitivity analyses conducted by varying the included indicators. Poisson regression with interrupted time-series analysis was conducted to examine monthly age and gender-standardised mortality rates in the Irish population, ages >= 35 years, stratified by tertiles of SES indicators. All models were adjusted for time trend, season, influenza, and smoking prevalence. Results: Post-ban mortality reductions by structural SES indicators were concentrated in the most deprived tertile for all causes of death, while reductions by material SES indicators were more equitable across SES tertiles. The composite indices mirrored the results of the discrete indicators, demonstrating that post-ban mortality decreases were either greater or similar in the most deprived when compared to the least deprived for all causes of death. Conclusions: Overall findings indicated that the national Irish smoking ban reduced inequalities in smoking-related mortality. Due to the higher rates of smoking-related mortality in the most deprived group, even equitable reductions across SES tertiles resulted in decreases in inequalities. The choice of SES indicator was influential in the measurement of effects, underscoring that a differentiated analytical approach aided in understanding the complexities in which structural and material factors influence mortality. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Public Library of Science en
dc.rights © 2015 Stallings-Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited en
dc.rights.uri http://creativecommons.org/licenses/by/4.0/ en
dc.subject Secondhand smoke en
dc.subject Childhood asthma en
dc.subject Social class en
dc.subject Hospital admissions en
dc.subject Free legislation en
dc.subject Housing tenure en
dc.subject Heart disease en
dc.subject Health survey en
dc.subject Car access en
dc.subject Inequalities en
dc.title Socioeconomic differentials in the immediate mortality effects of the national Irish smoking ban en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Zubair Kabir , Epidemiology and Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email: z.kabir@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.internal.wokid WOS:000336956300093
dc.description.status Peer reviewed en
dc.identifier.journaltitle PLOS ONE en
dc.internal.IRISemailaddress z.kabir@ucc.ie en
dc.identifier.articleid e98617


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© 2015 Stallings-Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Except where otherwise noted, this item's license is described as © 2015 Stallings-Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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