Intended for healthcare professionals


Educational differences in smoking: international comparison

BMJ 2000; 320 doi: (Published 22 April 2000) Cite this as: BMJ 2000;320:1102
  1. A E J M Cavelaars, research associatea,
  2. A E Kunst, senior researchera,
  3. J J M Geurts, research associateb,
  4. R Crialesi, senior researcherc,
  5. L Grötvedt, senior registrard,
  6. U Helmert, senior researchere,
  7. E Lahelma, professorf,
  8. O Lundberg, senior researcherg,
  9. J Matheson, senior researcherh,
  10. A Mielck, senior scientisti,
  11. N Kr Rasmussen, deputy directorj,
  12. E Regidor, epidemiologistk,
  13. M do Rosário-Giraldes, professorl,
  14. Th Spuhler, head of health sectionm,
  15. J P Mackenbach, professor (mackenbach{at}
  1. a Department of Public Health, Erasmus University, PO Box 1738, 3000 DR Rotterdam, Netherlands
  2. b Statistics Netherlands, PO Box 4481, 6401 CZ Heerlen, Netherlands
  3. c National Institute of Statistics, Servizio Studi Metodologica, 00198 Rome, Italy
  4. d Division for Health, Statistics Norway, PO Box 8131, N 0033 Oslo 1, Norway
  5. e Centre for Social Policy Research, Bremen University, D-28209 Bremen, Germany
  6. f Department of Public Health, University of Helsinki, PO Box 41, FIN 00014 Helsinki, Finland
  7. g Swedish Institute for Social Research, Stockholm University, 10691 Stockholm, Sweden
  8. h Social Survey Division, Office for National Statistics, Lonson SW1V 2QQ
  9. i GSF-Institute for Medical Informatics and Health Service Research, PO Box 1129, D 85758 Neuherberg, Germany
  10. j National Institute of Public Health, 2100 Copenhagen, Denmark
  11. k Department of Epidemiology, Ministry of Health, 28071 Madrid, Span
  12. l National School of Public Health, 1699 Lisbon, Portugal
  13. m Swiss Federal Statistical Office, Espace de l'Europe 10, CH2010 Neuchâtel, Switzerland
  1. Corresponding author: J P Mackenbach
  • Accepted 2 January 2000


Objective: To investigate international variations in smoking associated with educational level.

Design: International comparison of national health, or similar, surveys.

Subjects: Men and women aged 20 to 44 years and 45 to 74years.

Setting: 12 European countries, around 1990.

Main outcome measures: Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level.

Results: In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal.

Conclusions: These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.


  • Funding This study was supported by a grant from the European Union's Biomed-1 program (CT92-1068).

  • Conflict of interest None declared.

  • Accepted 2 January 2000
View Full Text