Regions in transition in Germany: Is area-level socioeconomic deprivation linked to adult smoking?

Abstract Background Tobacco smoking poses a preventable health risk. The prevalence of tobacco smoking is closely related to individual socioeconomic position (SEP). Research on area-level factors associated with smoking prevalence is limited. This study examines whether area-level socioeconomic deprivation is associated with smoking prevalence beyond individual-level SEP, using lignite mining regions as example of structurally weak regions in transition. Methods Cross-sectional data of 24,378 adults from the annual household survey ‘Socio-Economic Panel’ from 2022 were linked with the area-level ‘German Index of Socioeconomic Deprivation’ (GISD) based on the official district number of the residential district. Binary multilevel models [odds ratio (OR), 95% confidence interval] analysed the association between current self-reported smoking [no | yes 20.5%] and area-level socioeconomic deprivation [GISD, metric], while adjusting for individual-level equivalised net household income [high | medium | lower | low]. The analysis was repeated stratified by lignite mining region [no (N = 21,744, prevalence 20%) | yes (N = 2,634, prevalence 24%)]. Results Individual-level household income was associated with smoking (ORmedium=1.28, 1.16-1.41; ORlower=1.69, 1.53-1.87, ORlow=2.30, 2.08-2.54; all relative to high income). Higher area-level socioeconomic deprivation was additionally associated with smoking (OR = 1.19, 1.15-1.24). In stratified models, the estimated smoking prevalences increased with higher levels of area-level socioeconomic deprivation, peaking in the most deprived regions (other regions: 23%; lignite mining regions: 26%). Conclusions Adult smoking prevalence is associated with socioeconomic factors at both individual and area levels. Both individual and area socioeconomic factors should be taken into account when designing prevention measures. Longitudinal studies should focus on regions undergoing structural change, such as lignite mining regions. Key messages • Area-level socioeconomic deprivation is associated with adult smoking prevalence beyond individual-level socioeconomic position. • Regions undergoing structural change such as lignite mining regions should be of interest in longitudinal research of health and health behavior.