Educational differences in alcohol-related mortality and their impact on life expectancy and lifespan variation in Spain (2016–2018): a cross-sectional analysis using multiple causes of death

Trias‐Llimós, Sergi; Spijker, Jeroen

doi:10.1136/bmjopen-2021-053205

Cited by 13 publications

(10 citation statements)

References 56 publications

(114 reference statements)

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“…The finding of a greater educational gradient in alcohol‐related mortality among men than women is consistent with some previous research [3, 12, 61] but not others [6, 17]. The greater relative educational inequality at working than older ages is also consistent with previous research [13–17, 62, 63]. This age heterogeneity could be explained by selective mortality (people with alcohol‐related harm would die at a younger age in low‐ than high‐SEPs due to a greater accumulation of other harms and risk factors) [63] or by a greater contribution to alcohol‐related mortality of acute causes, occurring at younger ages, in low‐ than high‐SEPs [13, 14].…”

Section: Discussionsupporting

confidence: 91%

Increase in educational inequalities in alcohol‐related mortality in Spain during a period of economic growth

et al. 2023

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Background and aimsAlcohol‐related mortality risk is almost always greater in lower than higher socio‐economic positions (SEPs). There is little information on the evolution of this SEP gradient and its relationship with the economic cycle. Some results suggest that during economic expansions, there is a hypersensitivity of low‐SEP people to harmful drinking. The main objective of this study was to measure the evolution of educational inequality in alcohol‐related and non‐alcohol related mortality by sex and age group in Spain during 2012–19.Design, Setting and MeasurementsThis is a repeated cross‐sectional study. This study includes all residents in Spain aged 25 years and over from 2012 to 2019. (1) We calculated age‐standardized mortality rates (ASMRs) from strongly/moderately alcohol‐related causes (directly alcohol‐attributable, unspecified liver cirrhosis, liver and upper aerodigestive tract cancers and moderately alcohol‐related), weakly alcohol‐related causes and other causes by educational level. (2) We used age‐adjusted relative index of inequality (RII) and slope index of inequality (SII) to measure relative and absolute educational inequality in mortality, respectively. (3) Age‐adjusted annual percentage change (APC) was also used to measure linear trends in mortality by educational level. RII, SII and APC were obtained from negative binomial regression.FindingsBetween 2012–15 and 2016–19, economic growth accelerated, the RII in mortality from strongly/moderately alcohol‐related causes increased from 2.0 to 2.2 among men and from 1.1 to 1.3 among women, and the SII in deaths/100 000 person‐years from 181.4 to 190.9 among men and from 18.9 to 46.5 among women. It also increased relative and absolute inequality in mortality from weakly alcohol‐related and other causes of death in both men and women. These increases in inequality were due primarily to a flattening or even reversal of the downward mortality trend among low‐ and medium‐educated people.ConclusionsDuring the economic expansion of 2012–19 in Spain, changes in mortality risk from strongly/moderately alcohol‐related causes were especially unfavourable among low‐ and medium‐educated people.

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Section: Discussionsupporting

confidence: 91%

Increase in educational inequalities in alcohol‐related mortality in Spain during a period of economic growth

et al. 2023

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“…Yet, the impact of smoking on life expectancy we estimated (2.6 years for males and 0.6 years for females) is larger as compared with the one from alcohol using multiple causes of death estimates (0.15 years for males and 0.03 years for females). 36 Future research should therefore also look into the contribution of other behavioural risks factors such as diet or physical inactivity, and particularly on the joint contribution of multiple lifestyles to social inequalities in health and mortality, in line with recent research. 31 37 …”

Section: Discussionmentioning

confidence: 93%

Estimation of smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain: an observational study, 2016–2019

et al. 2022

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ObjectiveTo estimate smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain.DesignNationwide, observational study from 2016 to 2019. Population-attributable fractions were used to estimate age, sex and education-specific cause-of-death smoking-attributable mortality. Life table techniques and decomposition methods were used to estimate potential gains in life expectancy at age 35 and the cause-specific contributions of smoking-related mortality to life expectancy differences across educational groups.SettingSpain.ParticipantsWe use cause-specific mortality data from population registers and smoking prevalence from the National and the European Health Survey for Spain from 2017 and 2019/2020, respectively.ResultsWe estimated 219 086 smoking-related deaths during 2016–2019, equalling 13% of all deaths, 83.7% of those in men. In the absence of smoking, potential gains in male life expectancy were higher among the low-educated than the high-educated (3.1 vs 2.1 years). For women, educational differences were less and also in the opposite direction (0.6 vs 0.9 years). The contribution of smoking to life expectancy differences between high-educated and low-educated groups accounted for 1.5 years among men, and −0.2 years among women. For men, the contribution of smoking to these differences was mostly driven by cancer in middle age, cardiometabolic diseases at younger ages and respiratory diseases at older ages. For women, the contribution to this gap, although negligible, was driven by cancer at older ages among the higher educated.ConclusionsSmoking remains a relevant preventable risk factor of premature mortality in Spain, disproportionately affecting life expectancy of low-educated men.

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“… 29 This method was recently applied to estimate the contribution of alcohol to life expectancy and lifespan variation in Spain. 30 …”

Section: Methodsmentioning

confidence: 99%

Cause-specific mortality in Spain during the pandemic: educational differences and its impact on life expectancy

Spijker

Trias‐Llimós

2023

European Journal of Public Health

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Background Life expectancy in Spain fell by 1 year between 2018/19 and 2020. Yet, little is known on the impact on cause-of-death (COD) dynamics and educational inequalities therein. Methods We use individual-level death counts data by age, sex, education and multiple causes of death (MCOD) and the corresponding population exposures from national registers in Spain. Deaths were examined both as underlying cause of death (UCOD) and as contributory cause. We estimated life expectancies and lifespan inequalities by subpopulation groups and decomposed life expectancy differences between 2018/19 and 2020 by age groups and COD to assess the impact of COVID-19 (as MCOD) and major UCOD. Results COVID-19 contributed to a decline in male and female life expectancy in Spain between 2018/19 and 2020 (respectively, −1.7 and −1.4 years). Conversely, cancer, respiratory and circulatory system diseases and ill-defined causes as UCOD contributed to life expectancy increases. Life expectancy declines equalled −1.4 years among the low-educated in both sexes (population 30+), −1.0 and −0.7 years among middle-educated and −1.1 and −0.9 years among high-educated men and women. Without COVID-19, educational inequalities in life expectancy would have remained at similar levels, whereas lifespan variation would have been lower (−22% for women and −8% for men). Conclusions Life expectancy declines in Spain in 2020 were mainly driven by COVID-19, with possible substitution effects, especially for respiratory system diseases (fewer deaths compared to 2018/19 when coded as UCOD but more as contributing cause). We therefore advocate analysing MCOD when studying changing COD patterns during the pandemic.

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Educational differences in alcohol-related mortality and their impact on life expectancy and lifespan variation in Spain (2016–2018): a cross-sectional analysis using multiple causes of death

Cited by 13 publications

References 56 publications

Increase in educational inequalities in alcohol‐related mortality in Spain during a period of economic growth

Increase in educational inequalities in alcohol‐related mortality in Spain during a period of economic growth

Estimation of smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain: an observational study, 2016–2019

Cause-specific mortality in Spain during the pandemic: educational differences and its impact on life expectancy

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