All-cause and cause-specific mortality attributable to educational inequalities in Spain

Background: Socioeconomic inequalities in mortality give key information for public health preventive policies. We aim to assess the magnitude of educational inequalities in cause-specific mortality in Spain (2016-21). Methods: We use mortality register and population exposure data for Spain for ind...

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Autores: Trias Llimós, Sergi, Riffe, Timoyhy Lloyd, Martín Roncero, Unai
Tipo de documento: artigo
Data de publicação:2025
País:España
Recursos:Universidad del País Vasco
Repositório:Addi. Archivo Digital para la Docencia y la Investigación
OAI Identifier:oai:dnet:addi________::628e20bbb966446347bdf646b5c17abd
Acesso em linha:http://hdl.handle.net/10810/79714
Access Level:Acceso aberto
Palavra-chave:excess mortality
inequalities
premature mortality
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spelling All-cause and cause-specific mortality attributable to educational inequalities in SpainTrias Llimós, SergiRiffe, Timoyhy LloydMartín Roncero, Unaiexcess mortalityinequalitiespremature mortalityBackground: Socioeconomic inequalities in mortality give key information for public health preventive policies. We aim to assess the magnitude of educational inequalities in cause-specific mortality in Spain (2016-21). Methods: We use mortality register and population exposure data for Spain for individuals aged 35-99 years for 2016-21. These data included information on age, sex, educational attainment, and causes of death. We estimated all-cause and age- and cause-specific mortality attributable to educational inequality (death counts, attributable fractions (AF), and years of life lost (YLL)) by treating the high education group as a counterfactual benchmark. Results: There were 426,449 average annual deaths in Spain in 2016-21, and we estimated 82,815 average annual deaths (42,867 males and 39,948 females) attributable to education inequality (AF of 19.5%). Deaths attributable to inequality were highly concentrated at ages 75 and over, yet the proportion of deaths attributable to educational inequality was higher at young ages (50% and 31% at ages 35-39 for males and females, respectively). Circulatory system causes of death were the leading cause in terms of deaths attributable to inequality in females (16,051 deaths, AF = 25.9%, YLL = 174,195) and the second cause in males (10,542 deaths, AF = 19.2%, YLL = 179,744). Neoplasms were the leading cause of death in males (10,868 deaths, AF = 16.1%, YLL = 230,958) but not in females (1,520 deaths, AF = 3.4%, YLL = 45,011). Conclusions: Educational inequality remains a major public health challenge; its population-level impact on mortality is higher compared to the impact of smoking. Public health interventions addressing gender-specific social determinants of inequalities in health have a great potential for reducing mortality.This study was supported with funding provided by the European Research Council (ERC-2019-COG agreement 864616, HEALIN) and by the Spanish Ministry of Science and Innovation (projects PID2023-148727OA-I00). STL acknowledges research funding from the Ramón y Cajal program of the Spanish Ministry of Science and Innovation (RYC2021-033123-I) and a “Beca Leonardo” from the BBVA Foundation (LEO23-2-9669-ECS-DEM-16). TR acknowledges funding from the Spanish Ministry of Science and Innovation (project PID2022-142762OA-I00).BioMed Central202620262025info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10810/79714reponame:Addi. Archivo Digital para la Docencia y la Investigacióninstname:Universidad del País VascoInglésinfo:eu-repo/grantAgreement/MCIN/PID2023-148727OA-I00/info:eu-repo/grantAgreement/MCIN/ PID2022-142762OA-I00/https://doi.org/10.1186/s12889-025-23661-9info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/4.0/© The Author(s) 2025.This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.oai:dnet:addi________::628e20bbb966446347bdf646b5c17abd2026-06-18T09:23:17Z
dc.title.none.fl_str_mv All-cause and cause-specific mortality attributable to educational inequalities in Spain
title All-cause and cause-specific mortality attributable to educational inequalities in Spain
spellingShingle All-cause and cause-specific mortality attributable to educational inequalities in Spain
Trias Llimós, Sergi
excess mortality
inequalities
premature mortality
title_short All-cause and cause-specific mortality attributable to educational inequalities in Spain
title_full All-cause and cause-specific mortality attributable to educational inequalities in Spain
title_fullStr All-cause and cause-specific mortality attributable to educational inequalities in Spain
title_full_unstemmed All-cause and cause-specific mortality attributable to educational inequalities in Spain
title_sort All-cause and cause-specific mortality attributable to educational inequalities in Spain
dc.creator.none.fl_str_mv Trias Llimós, Sergi
Riffe, Timoyhy Lloyd
Martín Roncero, Unai
author Trias Llimós, Sergi
author_facet Trias Llimós, Sergi
Riffe, Timoyhy Lloyd
Martín Roncero, Unai
author_role author
author2 Riffe, Timoyhy Lloyd
Martín Roncero, Unai
author2_role author
author
dc.subject.none.fl_str_mv excess mortality
inequalities
premature mortality
topic excess mortality
inequalities
premature mortality
description Background: Socioeconomic inequalities in mortality give key information for public health preventive policies. We aim to assess the magnitude of educational inequalities in cause-specific mortality in Spain (2016-21). Methods: We use mortality register and population exposure data for Spain for individuals aged 35-99 years for 2016-21. These data included information on age, sex, educational attainment, and causes of death. We estimated all-cause and age- and cause-specific mortality attributable to educational inequality (death counts, attributable fractions (AF), and years of life lost (YLL)) by treating the high education group as a counterfactual benchmark. Results: There were 426,449 average annual deaths in Spain in 2016-21, and we estimated 82,815 average annual deaths (42,867 males and 39,948 females) attributable to education inequality (AF of 19.5%). Deaths attributable to inequality were highly concentrated at ages 75 and over, yet the proportion of deaths attributable to educational inequality was higher at young ages (50% and 31% at ages 35-39 for males and females, respectively). Circulatory system causes of death were the leading cause in terms of deaths attributable to inequality in females (16,051 deaths, AF = 25.9%, YLL = 174,195) and the second cause in males (10,542 deaths, AF = 19.2%, YLL = 179,744). Neoplasms were the leading cause of death in males (10,868 deaths, AF = 16.1%, YLL = 230,958) but not in females (1,520 deaths, AF = 3.4%, YLL = 45,011). Conclusions: Educational inequality remains a major public health challenge; its population-level impact on mortality is higher compared to the impact of smoking. Public health interventions addressing gender-specific social determinants of inequalities in health have a great potential for reducing mortality.
publishDate 2025
dc.date.none.fl_str_mv 2025
2026
2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/10810/79714
url http://hdl.handle.net/10810/79714
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv info:eu-repo/grantAgreement/MCIN/PID2023-148727OA-I00/
info:eu-repo/grantAgreement/MCIN/ PID2022-142762OA-I00/
https://doi.org/10.1186/s12889-025-23661-9
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by/4.0/
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv reponame:Addi. Archivo Digital para la Docencia y la Investigación
instname:Universidad del País Vasco
instname_str Universidad del País Vasco
reponame_str Addi. Archivo Digital para la Docencia y la Investigación
collection Addi. Archivo Digital para la Docencia y la Investigación
repository.name.fl_str_mv
repository.mail.fl_str_mv
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