title: Socio-economic inequalities in tobacco-related diseases in Portugal: an ecological approach.
abstract: OBJECTIVE
  The existence of socio-economic (SE) inequalities in smoking is well demonstrated, but less is known about its consequences. This study measures SE inequalities in the prevalence of tobacco-related diseases (TRD) in Portugal, using a new area-based SE indicator.
  
  
  METHODS
  Ecological study.
  
  
  METHODS
  In-patient data were used to identify TRD discharges at all Portuguese NHS hospitals for the year 2011. The definition of TRD incorporates malignant cancers, cardiovascular diseases, cerebrovascular diseases and respiratory diseases. We created an area-based SE indicator on the basis of census data, using factor analyses. The association between the prevalence of TRD and the SE indicators was measured using Generalized Linear Models. The spatial correlation of this indicator was assessed using variograms.
  
  
  RESULTS
  Two area-based SE factors were identified at the parish level, reflecting (i) social position (education and occupation); and (ii) deprivation (overcrowding and manual occupations). Upper-social-class areas were associated with a lower prevalence of malignant cancers, cardiovascular, and respiratory diseases.
  
  
  CONCLUSIONS
  We found significant inequalities in TRDs across Portuguese parishes using a newly created area-based SE indicator reflecting several SE dimensions. This result emphasizes that inequalities in smoking are reflected in inequalities in health, and should be tackled through equality-oriented area-based tobacco policies.
authors.affiliation: Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal. Electronic address: joana.alves@ensp.unl.pt.
authors.forename: J
authors.initials: J
authors.lastname: Alves
authors.affiliation: Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal. Electronic address: CNunes@ensp.unl.pt.
authors.forename: C
authors.initials: C
authors.lastname: Nunes
authors.affiliation: Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal. Electronic address: JPerelman@ensp.unl.pt.
authors.forename: J
authors.initials: J
authors.lastname: Perelman
mesh_terms: D054624:Health Status Disparities; D006753:Hospital Records; D006801:Humans; D016014:Linear Models; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects*; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology*
keywords: Inequality; Socio-economic status; Tobacco-related diseases