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

dc.contributor.authorStallings-Smith, Sericea
dc.contributor.authorGoodman, Pat
dc.contributor.authorKabir, Zubair
dc.contributor.authorClancy, Luke
dc.contributor.authorZeka, Ariana
dc.description.abstractBackground: 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.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.identifier.citationStallings-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.journaltitlePLOS ONEen
dc.publisherPublic Library of Scienceen
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 crediteden
dc.subjectSecondhand smokeen
dc.subjectChildhood asthmaen
dc.subjectSocial classen
dc.subjectHospital admissionsen
dc.subjectFree legislationen
dc.subjectHousing tenureen
dc.subjectHeart diseaseen
dc.subjectHealth surveyen
dc.subjectCar accessen
dc.titleSocioeconomic differentials in the immediate mortality effects of the national Irish smoking banen
dc.typeArticle (peer-reviewed)en
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