England: Smoking highlights health inequalities in Bristol city

High smoking rates in the city of Bristol in southwest England have highlighted health inequalities, according to the city's public health department's 2021 annual report.[1]There is a wide variation in smoking rates, concentrated among more disadvantaged communities and groups.

Smoking remains the leading cause of preventable ill health and premature death, the leading driver of health inequalities and the leading risk factor in pregnancy. According to the Bristol Public Health Department report, residents’ health inequalities have widened since the Covid19 pandemic, even though smoking is a contributing risk factor.

A prevalence that remains high in the most disadvantaged neighborhoods

The number of smokers in Bristol had been steadily decreasing from 21.1 per cent in 2011 to 16.3 per cent in 2018. However, recent data indicates that smoking in Bristol is increasing again to 18.1 per cent of the population in 2021, higher than the UK average of 13.9 per cent and the second highest rate of any major city in England.[2]. Beyond the overall observation of a recovery in consumption, there are large variations in this local smoking depending on the city's neighborhoods. In some deprived neighborhoods (Ashley or Southville), up to 40% of households are smokers compared to only 3% in some more affluent neighborhoods (Heanleaze or Redland). On average, the smoking rate is 27% in deprived neighborhoods compared to less than 10% in more affluent neighborhoods.

Smoking-related illness and mortality higher than nationally

In 2018/19, there were 4,053 smoking-related hospital admissions in Bristol, a rate of 2,102 per 100,000 population. This rate continues to be significantly higher than the national average (1,612 per 100,000) and has increased compared to the previous year.

In terms of mortality, there were 1,645 deaths attributable to smoking in Bristol over the same period, a rate of 285 smoking-related deaths per 100,000 population (compared to 217 per 100,000 population nationally).

These differences in smoking prevalence between Bristol and the rest of the country and within the city itself between different more or less socially advantaged neighbourhoods therefore translate into differentiated mortality. Between 2015 and 2019, 35% of all premature deaths caused by respiratory diseases occurred in the most deprived neighbourhoods of Bristol, compared to only 7% in the most advantaged neighbourhoods.

According to the authors of the report, the city of Bristol must strengthen its smoking cessation services, particularly for vulnerable and at-risk populations, such as pregnant women and people living with long-term conditions.

Keywords: Bristol, England, smoking, health inequalities

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