Decomposition of socioeconomic inequalities in smoking status in Indonesia: a decade of widening gaps

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-07-26 DOI:10.1016/j.cegh.2025.102147

Wahyu Pudji Nugraheni , Bunga A. Paramashanti , Sinta Dewi Lestyoningrum , Dea Anita Ariani Kurniasih , Haerawati Idris

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引用次数: 0

Abstract

Background

Tobacco consumption persists as a significant global health issue. In Indonesia, smoking rates have changed little despite various policies, potentially due to underlying socioeconomic disparities. This study provides the first comparative assessment of socioeconomic inequalities in smoking behavior in Indonesia over ten years.

Objective

To quantify socioeconomic inequality in smoking status in Indonesia and determine the contribution of different factors to this inequality.

Methods

We utilized two nationally representative surveys from Indonesia, conducted in 2013 (Basic Health Research) and 2023 (Indonesia Health Survey). The sample was individuals aged >15 years. Socioeconomic inequality was measured using the concentration curve and the Wagstaff-normalised concentration index. We applied concentration index decomposition to determine the relative contributions of demographic, socioeconomic, and health-related factors.

Results

The concentration indices for smoking were −0.060 (p < 0.001) in 2013 and -0.089 (p < 0.001) in 2023, indicating a pro-poor concentration of smoking that widened over time. The decomposition analysis revealed that household socioeconomic status and education level were key factors explaining the pro-poor inequalities in smoking status in Indonesia in both 2013 and 2023. Additionally, occupation type contributed to the inequality in 2013, while insurance ownership emerged as a contributing factor in 2023.

Conclusion

There is an increase in socioeconomic inequalities in smoking behavior in Indonesia from 2013 to 2023. Tobacco control efforts should prioritize equity by enhancing health education, expanding culturally tailored cessation support, adopting innovative motivation tools to support quitting, and integrating cessation services into the national health insurance system.

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印尼吸烟状况的社会经济不平等分解：差距扩大的十年

烟草消费仍然是一个重大的全球健康问题。在印度尼西亚，尽管采取了各种政策，但吸烟率几乎没有变化，这可能是由于潜在的社会经济差距。本研究首次对印尼十年来吸烟行为的社会经济不平等进行了比较评估。目的量化印尼吸烟状况的社会经济不平等，并确定不同因素对这种不平等的贡献。方法：我们利用了2013年（基础健康研究）和2023年（印度尼西亚健康调查）在印度尼西亚进行的两次具有全国代表性的调查。样本是年龄在15岁的个体。社会经济不平等是用浓度曲线和瓦格斯塔夫标准化浓度指数来衡量的。我们应用浓度指数分解来确定人口、社会经济和健康相关因素的相对贡献。结果吸烟浓度指标为- 0.060 (p <；0.001)和-0.089 (p <；2023年的数据为0.001)，这表明吸烟的集中程度随着时间的推移而扩大。分解分析显示，家庭社会经济地位和教育水平是解释2013年和2023年印度尼西亚吸烟状况中亲穷人不平等的关键因素。此外，职业类型在2013年导致了不平等，而保险所有权在2023年成为一个促成因素。结论从2013年到2023年，印度尼西亚吸烟行为的社会经济不平等有所增加。烟草控制工作应优先考虑公平问题，加强健康教育，扩大适合文化的戒烟支持，采用创新的激励工具来支持戒烟，并将戒烟服务纳入国家健康保险系统。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.