Intersectional analysis of smoking behavior changes in Koreans with disabilities across COVID-19

Background

While South Korea’s COVID-19 distancing policies were highly effective, the resulting decline in smoking among people with disabilities requires contextual interpretation. Beyond mere health promotion, these shifts may mask deeper, intersecting vulnerabilities. This study utilizes an intersectional lens to explore this unequal burden across gender, disability severity, and type.

Methods

A nationwide population-based study was conducted using the National Health Insurance Service database (2018–2022). A Difference-in-Differences (DID) generalized linear model (GLM) was used. Adjusted Odds Ratios (aOR) and 95% Confidence Intervals (CI) were calculated by adjusting for age, income, region, and Charlson Comorbidity Index (CCI) scores, following a multi-layered intersectional framework.

Results

Smoking odds declined for both men (aOR=0.98) and women (aOR=0.93). The reduction was most pronounced among women with mild disabilities (aOR=0.92, 95% CI: 0.88-0.97), showing 2.15 times stronger decline than men (aOR=0.96, 95% CI: 0.95-0.98). No significant change was observed among those with severe disabilities. Analysis by disability type among women revealed that significant reductions were concentrated in physical (aOR=0.93, p = 0.018) and sensory/speech (aOR=0.89, p = 0.013) disabilities, whereas no significant changes were found for brain injury, developmental/mental, or major internal organ disabilities (all p > 0.05). For men, no disability types showed significant changes.

Conclusions

Demonstrating the prevention paradox, population-level distancing asymmetrically compounded intersecting gender and disability vulnerabilities. Smoking declines among women with mild, physical, or sensory disabilities suggest involuntary changes from environmental and social constraints. However, absence of significant changes among those with brain injury, developmental, or internal organ disabilities underscores the need for tailored, disability-specific disaster policies.

Key messages

• Intersectional analysis reveals COVID-19 distancing policies asymmetrically compounded vulnerabilities, causing involuntary smoking declines among women with mild, physical, or sensory disabilities.

• Demonstrating the prevention paradox, statistical improvements in smoking masked deeper social isolation. Future disaster policies require tailored approaches addressing intersectional inequalities.