Educational differences in smoking: international comparison.

OBJECTIVE: To investigate international variations in smoking associated with educational level. DESIGN: International comparison of national health, or similar, surveys. SUBJECTS: Men and women aged 20 to 44 years and 45 to 74 years. SETTING: 12 European countries, around 1990. MAIN OUTCOME MEASURES: Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. RESULTS: In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. CONCLUSIONS: These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.

Allocative efficiency in the use of health resources in Portugal.

BACKGROUND: This is the first time that a resource allocation technique based on a marginal met need approach has been used in Portugal, and the objective of the study is to attain the improvement of allocative efficiency. METHODS: The utilities of health states with and without treatment have been measured using the rating scale technique and a cost-utility analysis has been made. The value resulting from multiplying the avoided days of incapacity by a weight, on a scale from zero to one, has been considered as an indicator of utility corresponding to the difference between a health state with and without treatment. This study has been carried out using the main causes of morbidity from the National Health Survey, 1987, at a regional level. A sample of 150 local authorities was considered to be sufficient. A second objective of this study was to carry out a cost-utility analysis for the main causes of declared morbidity. RESULTS: This analysis has shown that the ratio of cost-utility is highest for hypertension, followed by influenza, asthma and digestive ill-functioning. Pharyngitis-amygdalitis, cold, osteoarthrosis, chronic bronchitis, spondylous arthrosis and diabetes are the illnesses with a more favourable cost-utility ratio which, in a rational resource allocation, should be treated first. CONCLUSIONS: So that an increase in the allocative efficiency could be achieved, a transfer of resources between regions is required up to the point at which the use of these resources would be equally efficient. Resources should be transferred from two regions - Interior Centre Region and Littoral Lisbon Region - towards all the other regions, in particular the Interior North Region.