Background

Smoking is the largest cause of cancer in England. Clear socio-economic inequalities exist for both smoking prevalence and cancer incidence, meaning that more deprived populations typically experience higher cancer incidence rates and smoking prevalence compared to less deprived populations. It is hypothesised that the least deprived population will have a lower proportion of cancer caused by smoking compared to more deprived populations.

Method

Cancer incidence by deprivation data (2013-2017) for England on 15 different types of cancer that have a definite causal association with smoking, was provided by Public Health England upon request. The data set was split by sex, five-year age band, quintiles of the Income domain from the Index of Multiple Deprivation 2015 (IMD 2015) and International Classification of Diseases version 10 (ICD-10) 3-digit code. Smoking prevalence by deprivation was collated from Health Survey for England datasets (2003-2007), split by sex, 10-year age band and equivalised household income quintiles of deprivation. Relative risks were obtained from a systematic search of the literature. Population Attributable Fractions (PAFs) were calculated using the standard formula.

Results

A strong deprivation gradient was observed in both females and males for the proportion of cancers attributable to smoking. The proportion of smoking attributable cancers was around 2 times greater in the most deprived quintile compared to the least deprived quintile, for both sexes. A larger difference in the proportion of smoking attributable cancers between the least and most deprived quintile was observed in the ‘working age’ (25-64 years) population compared to those aged 65 and above.  

Conclusion

More deprived populations have a higher proportion of cancers caused by smoking compared to less deprived populations. Higher smoking prevalence in both females and males in more deprived groups is the main factor for the difference in the proportion of smoking attributable cancers between deprivation groups. To our knowledge, this is the first study to assess of the influence of deprivation on cancers attributable to smoking in England.

Impact statement

Policy makers should ensure that tobacco control policies target smoking inequalities to reduce the disproportionate number of preventable smoking related cancers which more deprived populations currently experience.