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

Abstract

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.

Age and cause-of-death contributions to educational inequalities in life expectancy and lifespan variation in a low-mortality country: A cross-sectional study of 1.67 million deaths in Spain (2016–19)

“…In men, most inequalities were concentrated at younger ages and were due to lung cancer, cardiovascular, respiratory and digestive diseases. A relatively large fraction of education gaps in mortality seems to be explained by behavioural-related causes of death such as lung, lip, pharynx and oesophagus cancers or respiratory diseases, which is well-aligned with previous research suggesting that smoking account for 1.5-year educational gap in life expectancy among men ( Piñeiro et al, 2022 ). Chronic liver diseases, which are partly caused by alcohol consumption, were also important in men, but not in women, and a similar story is observed for suicides and other external causes.…”

Trends in social inequality in mortality in Denmark 1995–2019: the contribution of smoking- and alcohol-related deaths

“…Even though most deaths occur in the oldest age groups, smoking- and alcohol-related deaths account for a larger proportion of deaths before age 65 years. 38 39 Also, educational level has been suggested to lose its discriminatory power at higher ages. 30 Accordingly, we assume that the contribution of smoking- and alcohol-related mortality on trends in social inequality is strongest among individuals in an age range included in this study.…”

Trends in cause-specific mortality: deaths of despair in Spain, 1980–2019

“…Concurrently, women’s smaller educational inequalities in mortality may be due to the effect of the later socioeconomic modernization, which led to a delay in the adoption of smoking, especially among less educated women. 28 , 29 Accordingly, the relationship between men and women mortality rates is heavily influenced by epidemiological and social circumstances and behavioral differences. 30 …”