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Contribution of smoking and alcohol consumption to income differences in life expectancy: evidence using Danish, Finnish, Norwegian and Swedish register data
  1. Olof Östergren1,
  2. Pekka Martikainen1,2,3,
  3. Lasse Tarkiainen2,
  4. Jon Ivar Elstad4,
  5. Henrik Brønnum-Hansen5
  1. 1 Department of Public Health Sciences, Stockholm University, Stockholm, Sweden, Europe
  2. 2 Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland, Europe
  3. 3 The Max Planck Institute for Demographic Research, Germany
  4. 4 NOVA, Centre for Welfare and Labour Research, Oslo Metropolitan University, Oslo, Norway
  5. 5 Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Olof Östergren, Department of Public Health Sciences, Stockholm University, Stockholm SE-106 91, Europe; Olof.Ostergren{at}


Background Despite being comparatively egalitarian welfare states, the Nordic countries have not been successful in reducing health inequalities. Previous studies have suggested that smoking and alcohol contribute to this pattern. Few studies have focused on variations in alcohol-related and smoking-related mortality within the Nordic countries. We assess the contribution of smoking and alcohol to differences in life expectancy between countries and between income quintiles within countries.

Methods We collected data from registers in Denmark, Finland, Norway and Sweden comprising men and women aged 25–79 years during 1995–2007. Estimations of alcohol-related mortality were based on underlying and contributory causes of death on individual death certificates, and smoking-related mortality was based on an indirect method that used lung cancer mortality as an indicator for the population-level impact of smoking on mortality.

Results About 40%–70% of the between-country differences in life expectancy in the Nordic countries can be attributed to smoking and alcohol. Alcohol-related and smoking-related mortality also made substantial contributions to income differences in life expectancy within countries. The magnitude of the contributions were about 30% in Norway, Sweden and among Finnish women to around 50% among Finnish men and in Denmark.

Conclusions Smoking and alcohol consumption make substantial contributions to both between-country differences in mortality among the Nordic countries and within-country differences in mortality by income. The size of these contributions vary by country and sex.

  • social inequalities
  • registers
  • mortality
  • smoking
  • alcohol

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  • Contributors The study was conceptualised by OÖ and PM. OÖ coordinated the work and was responsible for performing the analysis and drafting the manuscript. OÖ, PM, LT, JIE and HB-H were responsible for data acquisition and preparation, as well as developing and finalising the manuscript.

  • Funding This research is part of the C-life project (Nordforsk grant no. 75970). Additionally, OÖ is supported by the Strategic Research Council of the Academy of Finland (Decision Number: 293103) for the research consortium Tackling Inequality in Time of Austerity (TITA). PM is supported by the Academy of Finland and the European Union Horizon 2020 Programme under grant agreement 667661 (Promoting mental wellbeing in the ageing population—MINDMAP). The study does not necessarily reflect the Commission’s views and in no way anticipates the Commission’s future policy in this area. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests None declared.

  • Ethics approval Ethical permission for the use of data was granted by the local ethical review boards in each participating country.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it first published. Figure 2 labels have been corrected.

  • Patient consent for publication Not required.