Socioeconomic inequality in smoking: Evidence from a decomposition analysis

Abstract

Problem: Vietnam is a lower-middle-income country with a very high prevalence of smoking among men. The poor are more likely to smoke than the better off. In this study, we examine socioeconomic inequality in smoking and factors associated with the wealth-related inequality of smoking in Vietnam. Methods: We use data from the 2010 and 2015 Global Adult Tobacco Surveys (GATS). We use a concentration index approach to assess differences in smoking behavior over the distribution of wealth levels. We also use the regression-based decomposition method developed by Wagstaff et al. (2003) and Doorslaer and Koolman (2004) to decompose wealth-related inequality in smoking into inequalities in wealth and other explanatory variables, such as men's age and education. Results: Poorer men are more likely to smoke and smoke more than those better off. In 2015, 47.9% in the poorest wealth quintile smoked every day compared to 29.1% in the richest quintile. In 2015, the concentration index of wealth-related inequality in daily smoking was estimated at −0.104 (CI: 0.135; −0.072). Education and occupation are important factors in wealth-related inequality in smoking, because the poor tend to have lower education levels and are employed in unskilled jobs but are more likely than the rich to be smokers. At 41.4%, unskilled workers make the largest contribution to wealth-related inequality in smoking. Conclusions: Our findings suggest that tobacco prevention efforts should be focused on poor, less educated people. Policies that boost the access of the poor to education and better employment can help them not only increase their wealth level but also reduce smoking, thereby narrowing the wealth-inequality gap in smoking.

Keywords

• Smoking
• Socioeconomic inequality
• Tobacco control
• Decomposition
• Vietnam