Study On Smoking Inequality Among Middle-aged And Elderly In China Under Socioeconomic Status Ranking

Objective: With the aging of the population,the health problems caused by smoking are becoming increasingly prominent.Not enough attention has been paid to the health inequality of the middle-aged and the elderly caused by the socioeconomic status inequality of smoking in China.Therefore,this study takes middle-aged and older people as the research object,analyzes smoking inequality and its influencing factors in China,and explores measures to alleviate smoking inequality among middleaged and older people.Methods: Data of CHRALS 2011 baseline survey and 2018 follow-up Survey were used.Adults aged ≥45 years old in 2011 and 2018 were selected to improve sample data representativeness after excluding invalid and missing data,and adjusted individual weight of no response at the household level was used.Descriptive statistics and logistic regression were used to analyze the smoking status of middle-aged and older people of different genders and explore the influencing factors.Using the modified concentration index(EI)and concentration curve to analyze the smoking inequality among different populations.The EI values of smoking in different populations were decomposed,and the influencing factors of smoking inequality among middle-aged and older people in different regions and genders were explored.Results: In 2011 and 2018,16,471 and 19,367 people were included in the analysis,respectively,with an invalid and missing value rate of 4.5%.The study found that(1)the smoking rate of middle-aged and older women decreased from 5.49%(4.98%-6.05%)to 4.42%(3.98%-4.90%),while the smoking rate of middle-aged and older men did not change significantly.From 50.32%(48.78%-51.86%)to 50.02%(48.53%-51.51%).(2)Age,participation in social activities,occupation,type of medical insurance,regional distribution,household registration type,and socioeconomic status significantly influence smoking among middle-aged and older women.Age,chronic disease,participation in social activities,occupation,and socioeconomic status significantly influence smoking among middle-aged and older men.(3)Socioeconomic status inequality in smoking declined from 2011 to 2018,especially for men.Erreygers concentration index(ECI)was negative for women and men,indicating that smoking was still concentrated among middle-aged and older people with lower socioeconomic status.Moreover,the smoking inequality among middle-aged people in northeast China has increased significantly,and smoking is concentrated among people with low socioeconomic status.(4)For middle-aged and older women,education level was the biggest factor promoting the socioeconomic status inequality of smoking in central and northeastern regions.In western regions,the level of education was urban employee health insurance,while in eastern regions,the level of education changed from 2011 to 2018.Among middle-aged and older men,farming was the biggest factor contributing to socioeconomic status inequality in the eastern,central,and western regions in 2011.The western region changed to educational level in 2018,while the northeastern region changed from working in 2011 to hukou type in 2018.Conclusion: The smoking rate of middle-aged and older people in China has decreased in recent years,and the smoking inequality of male and female have eased to varying degrees.However,attention should be paid to the rising smoking inequality of the individual population.It is necessary to provide targeted policy interventions,focus on rural areas,improve urban-rural differences,reduce the rich and poor gap,strengthen health education,and appropriately raise tobacco taxes.