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

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).

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.

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).

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.