Relative and absolute socioeconomic inequality in smoking: time trends in Germany from 1995 to 2013

Research output: Contribution to journalResearch articleContributedpeer-review


  • Thaddäus Tönnies - , Heinrich Heine University Düsseldorf (Author)
  • Hermann Pohlabeln - , Leibniz Institute for Prevention Research and Epidemiology (Author)
  • Martin Eichler - , Department of internal Medicine I, University Cancer Centre, Johannes Gutenberg University Mainz, TUD Dresden University of Technology (Author)
  • Hajo Zeeb - , Leibniz Institute for Prevention Research and Epidemiology, University of Bremen (Author)
  • Tilman Brand - , Leibniz Institute for Prevention Research and Epidemiology (Author)


Purpose: This study aimed to investigate time trends in relative and absolute socioeconomic inequality in smoking prevalence in Germany using several indicators for socioeconomic position. Methods: We conducted a repeated cross-sectional study using representative samples of the German population aged between 25 and 64 years in 1995, 1999, 2005, 2009, and 2013 (n = 857,264). Socioeconomic position was measured by indicators for income, education, and occupation. Relative and absolute socioeconomic inequalities were estimated with the regression-based relative index of inequality and the slope index of inequality, respectively. Trends in inequalities were estimated with interaction terms for time and relative index of inequality/slope index of inequality. Results: Highest and increasing smoking prevalence was observed among long-term unemployed and people with less than 60% of the median household income. Between 1995 and 2013, relative increases in inequalities in smoking prevalence ranged from 31% (95% confidence interval, 26%–36%; men, occupation) to 94% (95% confidence interval, 84%–104%; women, education). Absolute increases ranged from 6.2 (95% confidence interval, 4.7–7.6) percentage points (men, occupation) to 20.3 (95% confidence interval, 18.9–21.7) percentage points (women, education). Conclusions: Relative and absolute socioeconomic inequalities in smoking prevalence increased in Germany between 1995 and 2013, with regard to income, education, and occupation, particularly among women.


Original languageEnglish
Pages (from-to)89-94.e2
Journal Annals of epidemiology
Publication statusPublished - Jan 2021

External IDs

PubMed 32920099
ORCID /0000-0001-9654-2207/work/142254147


ASJC Scopus subject areas


  • Education, Germany, Health disparities, Health inequalities, Income, Occupation, Smoking epidemic, Smoking prevalence