People living in the most deprived areas of England were more than four times more likely to smoke in 2016 than those living in the least deprived areas.
A person’s likelihood of smoking1 increased in line with the level of deprivation in their neighbourhood2, according to new analysis by Office for National Statistics (ONS) and Public Health England.
On national No Smoking Day, the analysis highlights a clear link between smoking and inequality; one which the Government plans to address by cutting the proportion of adults who smoke in England from 15.5% to 12.0% or less by the end of 2022.
Out of several measures of inequality, area deprivation – which combines factors such as income, employment, health and education within an area – had the greatest impact on someone’s likelihood of smoking.
The next most important factors were someone’s housing tenure and their occupational group.
People living in rented accommodation were more than three times more likely to smoke than those who weren’t renting.
Meanwhile, people in routine and manual jobs were three times more likely to smoke than those in managerial and professional jobs.
A person was also more likely to smoke if they reported having no qualifications, receiving benefits or having a health problem which severely limited their activity.
Likelihood of smoking compared with base category3, England, 2016
Smoking more common in deprived areas
Around 6.3 million people aged 18 and over in England smoked in 2016. These people were more concentrated in the most deprived areas than the least deprived areas.
Around one in six (16.0%) lived in the 10% most deprived neighbourhoods, compared with just 1 in 20 (5.2%) in the least deprived neighbourhoods.
It’s therefore no coincidence that many of the local authorities with the highest proportions of smokers in 2016 ranked among the most deprived in England.
More than one-quarter of people (25.7%) in Hastings smoked, the highest percentage in England, compared with a nationwide average of 15.5%.
Blackpool, Bradford and Hull in the North of England also ranked near the top for both smoking and deprivation.
In particular, Manchester and surrounding areas were home to a high percentage of smokers. As well as Manchester itself, at least one in five people smoked in Rossendale, Tameside, Knowsley and Salford.
At the opposite end of the smoking scale, just 4.9% of people smoked in Epsom and Ewell in Surrey (the lowest in England). Fewer than 1 in 10 people smoked in many of England’s least deprived areas, including places like Wokingham in Berkshire, Chiltern in Buckinghamshire and Waverley in Surrey.
Explore smoking prevalence by local authority in England in 2012 to 2016
Smoking contributes to health inequality
As smoking is more widespread in deprived areas, it’s not surprising that associated diseases like lung cancer and respiratory disease are more common too.
In 85% of cases where a patient has lung cancer, smoking is the biggest risk factor. Both men and women in England’s most deprived areas are roughly twice as likely to die from lung cancer compared with those in the least deprived areas.
Similarly, the NHS estimates that smoking is responsible for 9 out of 10 cases of a type of respiratory disease called chronic obstructive pulmonary disease (COPD). Deaths from respiratory diseases, including COPD, are more than twice as common in the most deprived places in England as the least deprived places.
But is it a declining habit?
Between 2012 and 2016, smoking declined at every level of area deprivation.
In 2016, 27.2% of adults living in England’s most deprived areas were smokers, down from close to one-third (32.7%) in 2012.
Meanwhile, just 7.9% of adults in the least deprived neighbourhoods smoked in 2016, compared with 10.0% in 2012.
Smoking prevalence by deprivation decile, England, 2012 and 2016
The data and analysis in this article refer to England only.
The ONS produces estimates for smoking prevalence across the UK using its Annual Population Survey (APS). However, devolved countries use statistics from their respective health surveys in Wales, Scotland and Northern Ireland to track progress against tobacco control targets.
Meanwhile, deprivation statistics are not comparable between England and the other devolved countries of the UK. Separate datasets are produced by the Welsh Government, Scottish Government and Northern Ireland Statistics and Research Agency (NISRA).
If you want to quit smoking, there are lots of resources available to help:
- find Stop Smoking services near you
- find out more about e-cigarettes and stop-smoking medicines
- join in the conversation on social media
- get email support
- download a free app to track your progress and get support
The analysis looked at the odds of smoking across several self-reported domains of inequality (including local area deprivation, education, disability and sexual identity) using data from the 2016 Annual Population Survey. For simplicity, we refer to the odds of smoking as the “likelihood of smoking”. An odds ratio (OR) is a measure of association between an exposure (for example, demographics such as age, sex, poor health, different housing tenure types) and an outcome (for example, whether someone smokes). The OR represents the odds that an outcome will occur given a particular exposure, compared with the odds of the outcome occurring in the absence of that exposure. More information about odds ratios and some example calculations can be found here.
Deprivation is an overall measure based on factors such as income, employment, health and education within an area. Deprivation in England is measured using the Index of Multiple Deprivation 2015 (IMD15). In this article, we split areas into deprivation deciles. Deciles are calculated by ranking the 32,844 neighbourhoods (lower layer super output areas (LSOAs)) in England from most deprived to least deprived and dividing them into 10 equal groups. These range from the most deprived 10% of neighbourhoods nationally to the least deprived 10%.
For each odds ratio calculation, there is a comparison group, referred to here as the “base category”. In our analysis the comparison group is that with largest sample size, and are as follows:
- Area deprivation – someone living in the 10% least deprived areas
- Housing tenure – someone who is not renting
- Occupational group – someone doing a managerial or professional job
- Marital status – someone who is married
- Disability status – someone whose activity is not limited at all
- Qualifications – someone with qualifications
- Sexual identity – someone who is heterosexual/straight
- Benefits status – someone not receiving benefits
- Gender – a female