Trends in educational and wealth inequalities in adult tobacco use in Nepal 2001–2016: secondary data analyses of four Demographic and Health Surveys

OBJECTIVE: To measure trends in socioeconomic inequalities tobacco use in Nepal. SETTING: Adults interviewed during house-to-house surveys. PARTICIPANTS: Women (15–45 years) and men (15–49 years) surveyed in four Nepal Demographic and Health Surveys done in 2001, 2006, 2011 and 2016. OUTCOME MEASURE: Current tobacco use (in any form). RESULTS: The prevalence of tobacco use for men declined from 66% in 2001 to 55% in 2016, and declined from 29% to 8.4% among women. Across both education and wealth quintiles for both men and women, the prevalence of tobacco use generally declines with increasing education or wealth. We found persistently larger absolute inequalities by education than by wealth among men. Among women we also found larger educational than wealth-related gradients, but both declined over time. For men, the Slope Index of Inequality (SII) for education was larger than for wealth (44% vs 26% in 2001) and changed very little over time. For women, the SII for both education and wealth were similar in magnitude to men, but decreased substantially between 2001 and 2016 (from 44% to 16% for education; from 37% to 16% for wealth). Women had a larger relative index of inequality than men for both education (6.5 vs 2.0 in 2001) and wealth (4.8 vs 1.5 in 2001), and relative inequality increased between 2001 and 2016 for women (from 6.5 to 16.0 for education; from 4.8 to 12.0 for wealth). CONCLUSION: Increasing relative inequalities indicates suboptimal reduction in tobacco use among the vulnerable groups suggesting that they should be targeted to improve tobacco control.