Social differentials in the impact of risk factor exposures on life expectancy and health expectancy

Aim: The study estimates the impact of exposure to smoking, high alcohol consumption and obesity on life expectancy and three health expectancy indicators by educational level and gender. Subject and methods: Gender-, educational- and risk factor-specific life tables were constructed using nationwide register data and the Danish National Health Survey in 2017. Health expectancies were estimated by Sullivan’s method. Results: Heavy smoking (15+ cigarettes daily) reduced life expectancy by 11.7 and 8.2 years among men with low and high education, respectively. The corresponding loss of life years for heavy smoking women was 10.7 and 7.3 years. No significant educational differences in the loss of 10–11 disease-free life expectancy was seen for male heavy smokers, in contrast to the loss of 13.7 and 9.1 years among female heavy smokers with low and high education. A social gradient in the loss of life expectancy was seen for the impact of high alcohol consumption for both genders and for loss of disease-free life expectancy for men. High alcohol consumption did not reduce disease-free life expectancy among women with medium and high education. There was no significantly different impact of obesity on disease-free life expectancy between educational groups. Educational differentials were seen for the impact of smoking and high alcohol consumption on loss of disability-free life expectancy and years in self-rated good health. Conclusion: Prevention targeted at people with low education can reduce social inequality in life and health expectancy. Particular attention should be paid to women with a low education.