Widening Educational Inequalities in Smoking and Physical Inactivity Among Adults in Germany Between 2003 and 2012

Background: Since the early 2000s, several tobacco control policies, such as increasing tobacco taxes or bans of tobacco advertising, and physical activity initiatives have been implemented in Germany. The aim of this study was to investigate whether educational inequalities in smoking and physical inactivity have decreased or increased over recent years.

Methods: We used data from three cross-sectional national telephone surveys of adults in Germany carried out in 2003, 2009 and 2012 (n=37,052; age=25–69 years). Participants who smoked daily or occasionally were classified as smokers. Physical inactivity was defined as not engaging in sports or reporting 2 or less hours of sporting activity per week. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in smoking and sporting inactivity, stratified by survey year and adjusted for age and sex.  

Results: In each survey year, smoking and physical inactivity were associated with lower education. Among the highly educated, the prevalence rates of smoking and sporting inactivity declined significantly between 2003 and 2012. Among the low-educated, these rates remained stable over time. Absolute and relative educational inequalities in smoking increased significantly between 2003 (SII=19.9; RII=1.81) and 2012 (SII=24.1; RII=2.28) (p-trend<0.05, respectively). With regard to physical inactivity, absolute and relative inequalities were also found to have significantly increased from 2003 (SII=16.3; RII=1.29) to 2012 (SII=31.7; RII=1.76) (p-trend<0.001, respectively).

Conclusions: The findings indicate that educational inequalities in behavioural risk factors for chronic diseases and premature death have widened in the adult population of Germany since the early 2000s. These trends could lead to increases in social inequalities in health and life expectancy in the future. Inequalities should be considered in the evaluation of public health policies.