Changing contribution of smoking to the sex differences in life expectancy in Europe, 1950-2014.

This article provides a detailed and overarching illustration of the contribution of smoking to sex differences in life expectancy at birth (e0) in Europe, focusing on changes over time and differences between both European countries and European regions. For this purpose, the sex difference in e0 for 31 European countries over the 1950-2014 period was decomposed into a smoking- and a non-smoking-related part, using all-cause mortality data and indirectly estimated smoking-attributable mortality rates by age and sex, and a formal decomposition analysis. It was found that smoking-attributable mortality contributed, on average, 3 years (43.5%) to the 7-year life expectancy difference between women and men in 2014. This contribution, was largest in 1995, at 5.2 out of 9.0 years, and subsequently declined in parallel with the average sex difference in life expectancy. The average contribution of smoking-attributable mortality was especially large in North-Western Europe around 1975; in Southern Europe around 1985; and in Eastern Europe around 1990-1995, when smoking-attributable mortality reached maximum levels among men, but was still low among women. The observed parallel decline from 1995 onwards in the sex differences in e0 and the absolute contribution of smoking to this sex difference suggests that this recent decline in the sex difference in e0 can be almost fully explained by historical changes in sex differences in smoking, and, consequently, smoking-attributable mortality. In line with the progression of the smoking epidemic, the sex differences in life expectancy in Europe are expected to further decline in the future.