Arthritis has the highest HRQL impact in the general population of the countries studied due to the combination of a high deviation score on physical scales and a high frequency. Impact of chronic conditions on HRQL was similar roughly across countries, despite important variation in prevalence. The use of HRQL measures such as the SF-36 should be useful to better characterize the global burden of disease.

dementia in general to any substantial extent. If anything, persistent smoking may increase rather than decrease the onset rate of dementia, but any net effect on severe dementia cannot be large in either direction.We thank the British doctors some of whom have continued to collaborate in this prospective study of their health for almost half a century, Robert Clarke, Rory Collins, and Christina Davies for their comments, and Cathy Harwood and Gale Mead for preparing the manuscript.Contributors: RD planned the study, IS has for many years conducted it, and RD, RP, and JB planned and conducted the present analyses. RD and RP prepared the report; they will act as guarantors for the paper.Funding: The Medical Research Council has supported the study since 1951 and continues to do so through direct support of the Clinical Trial Service Unit and Epidemiological Studies Unit, helped by the Imperial Cancer Research Fund and British Heart Foundation.Competing interests: None declared. 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. IntroductionSocioeconomic inequalities in health have been found in all countries where data are available, and there is an Until now only a few studies have compared the magnitude of socioeconomic differences in smoking between countries. [5][6][7] The most comprehensive comparison described differences in prevalence of smoking by educational level in the United Kingdom, Finland, Sweden, Norway, and France around 1987. 6 In all these countries, lower educated people smoked more than higher educated people. The largest differences were observed in ...

The aim of the study was epidemiologically to evaluate the long-term effects of opioids on pain relief, quality of life and functional capacity in long-term/chronic non-cancer pain. The study was based on data from the 2000 Danish Health and Morbidity Survey. As part of a representative National random sample of 16,684 individuals (>16 years of age), 10,066 took part in an interview and completed a self-administered questionnaire. Cancer patients were excluded. The interview and the self-administered questionnaire included questions on chronic/long-lasting pain (>6 months), health-related quality of life (SF-36), use of the health care system, functional capabilities, satisfaction with medical pain treatment and regular or continuous use of medications. Participants reporting pain were divided into opioid and non-opioid users. The analyses were adjusted for age, gender, concomitant use of anxiolytics and antidepressants and pain intensity. Pain relief, quality of life and functional capacity among opioid users were compared with non-opioid users. Opioid usage was significantly associated with reporting of moderate/severe or very severe pain, poor self-rated health, not being engaged in employment, higher use of the health care system, and a negative influence on quality of life as registered in all items in SF-36. Because of the cross-sectional nature causative relationships cannot be ascertained. However, it is remarkable that opioid treatment of long-term/chronic non-cancer pain does not seem to fulfil any of the key outcome opioid treatment goals: pain relief, improved quality of life and improved functional capacity.

There are large variations between chronic diseases in the size and pattern of socioeconomic differences in their prevalence. The large inequalities that are found for some specific fatal diseases (e.g. stroke) and non-fatal diseases (e.g. arthritis) require special attention in equity-oriented research and policies.

A series of health surveys are conducted every sixth to seventh year in Denmark. In the most recent survey of 2000, a national random sample (>16 years) was drawn from the Danish Central Personal Register. Out of the original sample 12,333 (74%) were interviewed and of these 10,066 returned a completed questionnaire (SF-36). The present study includes only those who both took part in the interview and the postal questionnaire. Cancer patients were excluded. Persons suffering from chronic pain (PG) were identified through the question 'Do you have chronic/long lasting pain lasting 6 months or more'? An overall chronic pain prevalence of 19% was found -16% for men and 21% for women. Prevalence of chronic pain increased with increasing age. Persons >/=67 years had 3.9 higher odds of suffering from chronic pain than persons in the age group 16-24 years. Compared with married persons, divorced or separated persons had 1.5 higher odds of chronic pain. Odds for chronic pain were 1.9 higher among those with an education of less than 10 years compared with individuals with an education of 13 years or more. During a 14-day period reporters of chronic pain had an average of 0.8 days (range 0-10) lost due to illness compared with an average of 0.4 days (range 0-10) for the control group (CG) (Odds Ratio (OR)) 2.0). Persons with a job which required high physical strain were more likely to report chronic pain compared with those with a sedentary job (OR 2.2). The odds of quitting one's job because of ill health were seven times higher among people belonging to the PG. A strong association between chronic pain and poor self-rated health was also demonstrated. The PG had twice as many contacts with various health professionals compared with the CG, and the health care system was, on average, utilised 25% more (overall contacts) by the PG than by the general population. Among the persons in the PG, 33% were not satisfied with the examinations carried out in connection with their pain condition and 40% were not satisfied with the treatment offered. Nearly 130,000 adults, corresponding to 3% of the Danish population, use opioids on a regular basis. Opioids are used by 12% of the PG.