Smoking
Smoking is the most important cause of preventable ill health and premature mortality in the UK. Smoking is a major risk factor for many diseases, such as lung cancer, chronic obstructive pulmonary disease (COPD) and heart disease. It is also associated with cancers in other organs, including lip, mouth, throat, bladder, kidney, stomach, liver and cervix. Smoking is a modifiable behavioural risk factor; effective tobacco control measures can reduce the prevalence of smoking in the population.
The Government’s Tobacco Control Plan (Towards a Smokefree Generation: A Tobacco Control Plan for England, published in July 2017 sets out the Government’s strategy to reduce smoking prevalence among adults and young people, and to reduce smoking during pregnancy.
In the UK, in 2023, 11.6% of people aged 18 years and over smoked cigarettes, this is the lowest proportion of current smokers since records started in 2011 based on estimates from the Annual Population Survey (APS). The trend in smoking prevalence continued to decrease, and the latest figure represents a 8.2 percentage point decrease in current smokers compared with 2011 (19.8%)
Those aged 25 to 34 years continued to have the highest proportion of current smokers (14.5%)when compared with any other age group, and those aged 70 years and over continued to have the lowest proportion of current smokers (8.0%, around 900,000 people). Across time, the largest reduction in smoking prevalence has been among those aged 18 to 24 years; 25.8% of this group smoked in 2011 compared with 10% in 2023, which is a reduction of 15.8 percentage points. Research from the University of Essex suggests that increased taxation on tobacco products has been effective at reducing smoking prevalence among those aged under 25 years.
Smoking is an important contributor to health inequalities. National data suggest that smoking rates are around 14.6% in the most deprived decile compared with 9.3% in the least deprived decile. National survey data show smoking rates above 23% in people employed in routine and manual jobs compared with around 9% for people in managerial and professional jobs. Smoking rates are also higher among people from white and mixed ethnic backgrounds, people with no religion, males, and in people with severe mental illnesses (Office for Health Improvement and Disparities).
Smoking Prevalence in adults (aged 18 and over) - current smokers (APS) (1 year range)
In the year 2023, smoking prevalence in adults (aged 18 and over) in Bury was 10.5%, statistically similar to England average of 11.6%. Trend data for Bury suggests that smoking prevalence declined steadily from a peak of 23.3% in 2011 to its current prevalence in 2023, where as England also saw a similar steady decline from 19.8% in 2011 to 11.6% in 2023. No trend data based on the five most data points are available for Bury and England.
Figure 1: Smoking prevalence in adults (aged 18 and over) - current smokers (APS) (1 year range) in Bury and England from 2011-2023
Bury has the 9th highest smoking prevalence in its group of 16 similar local authorities with the highest prevalence in Tameside (15.9%) and lowest in Sutton (6%). Data on inequalities for Bury are present by sex, housing tenure and socioeconomic group. Data by sex for 2023 suggests that the prevalence of smoking among males in Bury was 12.4%, which was statistically similar to the overall Bury average of 10.5%. Among females, the smoking prevalence was 8.5%, also statistically similar to the local average (Figure 2). Trend data by sex from 2011 to 2023 for Bury suggests that the percentage of current smokers declined for both males and females over the period. In 2011, male smoking prevalence was 24.6% compared to 22% for females. This trend of higher male smoking rates continued through most of the years, although both groups saw a general decline. By 2020, the rates had nearly converged, with males at 12.3% and females at 11.3%. In 2022, female smoking prevalence briefly surpassed that of males, reaching 12.7% compared to 10.8%. However, in 2023, male smoking increased slightly to 12.4% while female smoking dropped to 8.5%, marking the lowest female rate.
Figure 2: Smoking prevalence in adults (aged 18 and over) - current smokers (APS) (1 year range) by Sex in Bury from 2011-2023
There is a clear association between housing tenure and smoking prevalence among adults in Bury in the year 2023. Smoking rates were significantly higher among those living in rented accommodation compared to homeowners. Specifically, 29.6% of adults renting from a local authority or housing association were current smokers (statistically higher than Bury average), the highest among all tenure types. This was followed by 21.1% of those renting privately. In contrast, smoking prevalence was much lower among homeowners, with only 6.2% of those owning their home outright and just 3.9% (statistically lower than Bury average) of those owning with a mortgage identified as current smokers.
Data by socioeconomic group (18-64 years) for Bury suggests that smoking is more prevalent among individuals in lower socioeconomic groups, highlighting a clear gradient in smoking behaviour linked to social and economic status. Smoking prevalence was highest among those who had never worked or were long-term unemployed, with 25.7% identified as current smokers. This was followed by individuals in routine and manual occupations, where 21.1% reported smoking. In contrast, smoking prevalence was significantly lower among those in intermediate occupations (7.9%) and lowest among those in managerial and professional roles (3.7%). Data by sex for England suggests higher prevalence in males of 13.4% (statistically worse than England average) and a lower prevalence of 9.9% (statistically better than England average) in females.
Smoking prevalence among adults varied by housing tenure in England for the year 2023. The highest rate was observed among those renting from a local authority or housing association, with 24.9% (statistically worse than England average) identified as current smokers. This was followed by 17.4% among those renting privately. In contrast, smoking rates were lower among homeowners. Among those owning their home with a mortgage, 7.9% were current smokers, while 6.7% of those owning outright reported smoking.
Data by deprivation shows increasing prevalence of smoking with increasing levels of deprivation. In 2023, the highest prevalence of smoking was in the most deprived decile at 21.7% and lowest in the least deprived decile at 6.2%.
Smoking prevalence in priority populations:
Below we will present detailed data on smoking prevalence in priority populations including routine and manual workers, adults with long term mental health conditions and pregnant women.
· Smoking prevalence in routine and manual workers
This indicator measures the prevalence of smoking among persons aged 18-64 years in the routine and manual group. The prevalence of smoking in routine and manual workers in Bury for the year 2023 was 21.1%, statistically similar to England average of 19.5%. Trend data for Bury from 2011 to 2023 indicate an overall decline in smoking prevalence, despite some fluctuations over the years. The highest recorded rate was 39.2% in 2011. This steadily decreased to a low of 19.5% in 2020. However, the prevalence rose again to 24.9% in 2021, before dropping to 17.1% in 2022. In 2023, there was a slight increase, with smoking prevalence reaching 21.1%. England saw a consistent decline in smoking prevalence in routine and manual workers from a peak of 32.1% in 2011 to the lowest prevalence of 19.5% in 2023. Bury has the 7th highest prevalence in routine and manual workers in its group of statistical neighbours with the highest prevalence in Bracknell Forest of 32.9% and lowest in Bexley of 5.9%.
Figure 3 below presents gap in smoking prevalence between the general adult population in Bury and adults in routine and manual occupation. It is important to present this gap because it highlights a persistent and significant health inequality linked to socioeconomic status. Adults in routine and manual jobs consistently show higher smoking rates compared to the general population, reflecting broader structural and social determinants of health. These differences may be influenced by factors such as increased work-related stress, lower access to cessation support, targeted tobacco marketing, and cultural norms within certain occupational settings. Understanding and addressing this gap is essential for designing effective, targeted public health interventions that aim to reduce smoking-related harm and promote health equity.
Between 2011 and 2023, the gap in smoking prevalence between routine and manual workers and the overall adult population in Bury showed notable fluctuations. The disparity was highest in 2011 at 15.9%, indicating a significant difference in smoking rates. Over the years, the gap generally trended downward, with marked reductions in 2015 (10.9%) and reaching its lowest point in 2022 at 5.4%. However, the trend was not linear; there were periods of increase, such as from 2016 to 2017 (10.8% to 13.1%) and a sharp drop from 2021 to 2022 (13.5% to 5.4%). By 2023, the gap had risen again slightly to 10.6%, suggesting a need for continued targeted public health interventions.
Figure 3: Gap in smoking prevalence in adults (aged 18 and over) - current smokers (APS) (1 year range) between routine and manual workers and adult population in Bury from 2011 to 2023
· Smoking prevalence in adults (18+) with a long-term mental health condition
Smoking prevalence in adults with a long-term mental health condition in Bury for the year 2022/23 was 20.6%, statistically similar to England average of 25.1%. Trend data for Bury indicates that smoking prevalence remained relatively stable with minor fluctuations between 2013/14 and 2016/17, ranging from 37.9% to 37.1%. A notable decline followed, with prevalence dropping sharply to 30.7% in 2017/18 and continuing to fall to 17.2% by 2020/21. However, this downward trend reversed slightly in the subsequent years, rising to 18.3% in 2021/22 and further to 20.6% in 2022/23. Prevalence in England declined from 35.3% in 2013/14 to 25.1% in 2022/23 (Figure 4).
Figure 4: Smoking prevalence in adults with a long term mental health condition (aged 18 and over) - current smokers (GPPS)in Bury and England, 2013/14 - 2022/23
Bury has the 2nd lowest prevalence in its group of 16 similar local authorities, with the highest prevalence in Telford and Wrekin (30.3%) and lowest in Stockport (19%). No data on inequities are present for Bury. Data from England for 2022/23 highlights disparities in smoking prevalence by sex among adults with long-term mental health conditions. In 2023, males in this group had a higher smoking prevalence, which was statistically worse than the Bury average for this indicator. In contrast, females with long-term mental health conditions had a smoking prevalence of 22.4%, which was statistically better than Bury average. Data by deprivation suggests a gradient with increasing prevalence by increasing levels of deprivation. The highest smoking prevalence in adults with a long-term mental health condition in the most deprived decile (28.5%) and lowest in the least deprived decile (20.5%). Data by age for England shows higher smoking prevalence in 18-54 years of age groups and lower in those aged 55 years and over. The highest prevalence is in the 35-44 years (27.1%) and 18-24 years (27%) age groups and lowest is in the 75+ years age group (6.8%).
· Smoking in early pregnancy:
Smoking during pregnancy is associated with a variety of adverse birth outcomes including low birth weight and preterm birth, increased risk of stillbirths, placental problems, restricted head growth and an increased risk of miscarriage. Health and developmental consequences among children have also been linked to prenatal smoke exposure, including poorer lung function, persistent wheezing, and asthma, possibly through DNA methylation and visual difficulties, such as strabismus, refractive errors, and retinopathy.
Based on the most recent data from 2023/24, 10% of pregnant women in Bury smoked at the time of booking appointment with midwife, lower (statistically significant) than 13.6% in England. No trend data are available for Bury and England. Bury has the eighth lowest percentage of pregnant women smoking at the time of booking appointment with midwife in its group of statistical neighbours, with the lowest percentage in Trafford of 6.3% and highest in Telford and Wrekin at 21.2%.
· Smoking status at time of delivery
This indicator is defined as the number of mothers known to be smokers at the time of delivery as a percentage of all maternities with known smoking status. A maternity is defined as a pregnant woman who gives birth to one or more live or stillborn babies of at least 24 weeks gestation, where the baby is delivered by either a midwife or doctor at home or in an NHS hospital.
The percentage of women who were known smokers at time of delivery has declined in Bury and England over the past decade. In the year 2023/24, the smoking status at the time of delivery in Bury was 7.5%, statistically similar to England average of 7.4%. From 2010/11 to 2023/24, Bury saw a general downward trend in the percentage of women smoking at the time of delivery, starting at 16.9% in 2010/11 and decreasing to 7.5% in 2023/24. Similarly, England experienced a downward trend, beginning at 13.6% in 2010/11 and reaching 7.5% in 2023/24 (Figure 5).
Local Services
Advise on quitting smoking in Bury are available from Quit smoking - Bury Council
Figure 5: Smoking status at time of delivery during the period 2010/11 to 2023/24 for Bury and England
Bury has the third lowest percentage (%) of women who are known smokers at the time of delivery in it's group of statistical neighbours in 2023/24 (with a statistically significant decreasing trend). The highest percentage is in Stockton-on-Tees at 10.6% and lowest in Stockport at 5.8%. There are no data on inequalities at Bury and England level.
Emergency hospital admissions for COPD (aged 35 years and over)
This indicator is designed to measure emergency hospital admissions for Chronic Obstructive Pulmonary Disease (COPD). COPD is the umbrella term for serious lung conditions that include chronic bronchitis and emphysema. COPD is usually prevalent in adults over the age of 35. As many as 3 million people suffer from COPD in the UK, of which only around a third of cases have been diagnosed. COPD is a serious lung disease for which smoking is the biggest preventable risk factor1.
People with COPD have difficulties breathing, primarily due to the narrowing of their airways and destruction of lung tissue. Typical symptoms include breathlessness when active, a persistent cough and frequent chest infections.
Smokers can often dismiss the early signs of COPD as a ‘smoker’s cough’, but if they continue smoking and the condition worsens, it can greatly impact on their quality of life. Large numbers of people with COPD are unable to participate in everyday activities such as climbing stairs, housework or gardening; with many even unable take a holiday because of their disease.
If a timely diagnosis is present, COPD is a condition that can be effectively managed in a primary care setting. This indicator therefore can help signpost those areas with lower rates of diagnosis and/or poor management of this condition.
Better identification of this condition is beneficial both for the patient, as a better quality of life is possible if managed effectively, and for health services with the reduction in the number of costly hospital admissions
This indicator is measured as directly age-standardised rate of emergency admissions to hospital for COPD in adults aged 35 and over. The rate in Bury for the year 2023/24 was 419 per 100,000, statistically worse than England average of 357 per 100,000. Examining trend in Bury, emergency hospital admissions for COPD in Bury showed a fluctuating pattern between 2010/11 and 2023/24. Initially, the rate slightly decreased from 469 to 468 by 2012/13, followed by a significant drop to 367 in 2013/14. The subsequent years saw moderate fluctuations. A notable rise occurred from 416 in 2016/17 to a peak of 497 in 2019/20. However, this was followed by a sharp decline to 188 in 2020/21, likely influenced by the COVID-19 pandemic. The rate then increased gradually to 300 in 2021/22, 406 in 2022/23 and 419 in 2023/24. Across England, the rate started at 410 in 2010/11 and showed a gradual decline over the years. By 2023/24, it had decreased to 357, indicating a slow but consistent national improvement (Figure 6).
Figure 6: Directly age-standardised rate of Emergency hospital admissions for COPD (aged 35 years and over) per 100,000 population in Bury and England from 2011-2023
Bury has the 5th highest rate of emergency hospital admissions for COPD in its group of 16 similar local authorities, with the highest rate in Tameside of 778 per 100,000 and lowest in Bracknell Forest of 199 per 100,000. Data on inequities are available by sex for Bury. In 2023/24, the rate for males (389) and females (447) was statistically similar to Bury average. Data for England are available by deprivation and sex for the year 2023/24. As the level of deprivation increases, the rate of emergency hospital admissions for COPD in England increases. The highest rate is in the most deprived decile at 632 per 100,000 and lowest in the least deprived decile at 219 per 100,000. The rate of emergency admissions for COPD in males (348 per 100,000) was lower (statistically significant) than Bury average for the year 2023/24. The rate in females was higher than Bury average at 363 per 100,000 for the year 2023/24.
Figure 8 below shows data for Bury wards on emergency hospital admissions for COPD from 2016/17 to 2020/2021 as a standardised admission ratio.
Mortality
Smoking remains the biggest single cause of preventable mortality and morbidity in the world(1). It still accounts for 1 in 6 of all deaths in England, and there exist huge inequalities in smoking related deaths: areas with the highest death rates from smoking are about three times as high than areas with the lowest death rates attributable to smoking.
In the UK, approximately 72% of lung cancer cases are caused by smoking. Additionally, around 86% of lung cancer deaths are attributed to tobacco smoking. These figures highlight the significant impact of smoking on both the incidence and mortality of lung cancer.
Directly standardised mortality rate from lung cancer:
The mortality rate from lung cancer, all ages (Persons) per 100,000 population for 2021-23 in Bury (60.7 per 100,000) was statistically higher than England average (47.5 per 100,000). The mortality rate from lung cancer declined steadily from a peak of 81.9 per 100,000 to the lowest rate of 58.8 per 100,000 in 2017-19, before rising to 63 per 100,000 in 2019-21 and then declining once again to 62.2 in 2020-22 and 60.7 in 2021-23. England saw a more gradual decline from a peak of 60.3 in 2011-13 to the lowest rate of 47.5 in 2021-12 (Figure 7).
Figure 7: Directly standardised mortality rate from lung cancer, all ages per 100,000 population for Bury and England from 2011-13 to 2021-23 (Mortality Profile, 2023)
Bury has the fourth highest mortality from lung cancer in its group of 16 statistical neighbours, with the lowest mortality in Havering of 40.5 per 100,000.
Data on inequalities in mortality rates from lung cancer for all ages in Bury are only available by sex. For the period 2021-23, cancer mortality in females (59.4 per 100,000) is slightly lower compared to males (63.9 per 100,000) in Bury. Compared with England, the mortality rate for males in Bury is statistically similar to the England average (54.7 per 100,000) and is the fifth highest amongst Bury’s statistical neighbours. In contrast, the rate for females in Bury is higher (statistically significant) than the England average for females (41.9 per 100,000) and is second highest amongst its group of similar local authorities.
Data by deprivation are available for England only and for 2021-23 it shows a steep deprivation gradient where individuals in the most deprived decile (69.3 per 100,000) have nearly two times higher cancer mortality rates compared with the least deprived decile (35.6 per 100,000).
Quitting smoking
Prior to the 2008/09 data collection, the NHS Information Centre collected quarterly data from local Stop Smoking Services via aggregated Strategic Health Authority (SHA) returns. From 2008/09 the data have been collected at PCT level, and from 2013 at LA level. Previously this indicator was calculated using the Integrated Household Survey (IHS), however in 2013 several survey modules were removed from the Integrated Household Survey (IHS) to leave a dataset solely based upon the Annual Population Survey (APS). Therefore, the ONS announced it would no longer produce the IHS. Instead the questions formerly regarded as the IHS core continue to be asked in the APS.
The APS is designated as a National Statistic and provides a consistent time series of data. Some differences in survey coverage, imputation and weighting methodology may result in some discontinuity for certain 'core' variables compared to estimates previously provided as part of the IHS and as a result the IHS and APS should not be directly compared. ONS have drafted a note (available here) to explain the differences further. NHS Digital are responsible for validating the data and ensuring that the data are as accurate and complete as possible.
· Smokers setting a quit date
This indicator presents crude rate of people setting a quit date per 100,000 smokers aged 16+ years. The rate in Bury for the year 2022/23 was 2,140, statistically worse than England average of 2,998. Examining trends for Bury, the rate declined from 2,402 in 2013/14 to the lowest rate of 1,911 in 2015/16. This was followed by an increase to a peak of 3,639 in 2017/18. The rate then remained stable at 3,507 in 2019/20. After this the rate declined from 3,413 in 2018/19 to 2,140 in 2022/23. The rate in England has steadily declined from 7,302 in 2013/14 to 2,998 in 2022/23 (Figure 8).
Figure 8: Crude rate of people setting a quit date per 100,000 smokers aged 16+ years in Bury and England from 2010/11-2022/23
Bury has the 8th highest crude rate of people setting a quit date per 100,000 smokers aged 16+ years in its group of similar local authorities, with the highest rate in Warrington (7,077) and lowest rate in Havering (245). No data on inequities are available for Bury and England.
· Smokers that have successfully quit at 4 weeks (CO validated)
This indicator is a guide to how effective local NHS Stop Smoking Services are at helping people quit smoking and how many people are stopping smoking as a result of the service in the area. It is recognised that in certain cases some time may need to be spent with clients before they are ready to set a quit date. However, only actual quit attempts are counted for national monitoring. CO validated smoking quits provide an objective measure in addition to self-reported quits, and CO validation may also help incentivising clients to quit.
This indicator is defined as rate of successful quitters (CO validated) at 4-weeks per 100,000 smokers.
England and the North West have both followed a very similar decline pattern over time. Bury has fewer quitters but has remained stable over the same period.
The rate in Bury for the year 2022/23 was 115, statistically worse than England average of 237. Examining trends for Bury, the rate of admissions declined steadily from 1,438 in 2013/14 to 1,009 in 2019/20. This was followed by a sharp drop to just 77 in 2020/21, likely reflecting the impact of the COVID-19 pandemic, before rising slightly to 115 in 2022/23. A similar pattern was observed across England, where rates fell from 2,625 in 2013/14 to 1,113 in 2019/20, then dropped sharply to 49 in 2020/21, with a modest increase to 237 by 2022/23 (Figure 9).
Figure 9: Rate of successful quitters (CO validated) at 4-weeks per 100,000 smokers aged 16+ in Bury and England from 2010/11-2022/23
Bury has the 10th highest rate of successful quitters (CO validated) at 4-weeks per 100,000 smokers aged 16 years in its group of similar local authorities, with the highest rate in Bracknell Forest (1,988) and lowest rate in Tameside (3). No data on inequities are available for Bury and England.