Eur J Health Econ. 2026 Jun 2. doi: 10.1007/s10198-026-01943-2. Online ahead of print.
ABSTRACT
Longevity and death rates are closely linked to socioeconomic conditions. However, the relationship between income and specific causes of death (CoD) remains insufficiently explored. This study examines socioeconomic inequalities in cause-specific mortality in Spain, simultaneously accounting for CoD, age, sex, and income. To the best of our knowledge, no previous study has jointly combined all these variables. Using data for the entire population residing in Spain from 2010 to 2019, we compute death rates by CoD, age, sex, and income decile by linking individual demographic records with census tract-level disposable income. The analysis covers 4 million deaths and over 466 million person-years at risk. Robust income-based relative risks and gradients by CoD are calculated for five-year age groups, stratified by sex, while Relative Index of Inequality (RII) values are derived for single years of age. Results show strong and consistent income-related inequalities in mortality across age, CoD, and sex, especially among younger and middle-aged groups. Particularly steep and significant gradients are found for circulatory, respiratory, digestive, infectious, endocrine, and genitourinary diseases, as well as for symptoms and abnormal findings, and other conditions, with lower-income individuals facing markedly higher risks. For neoplasms, nervous, mental and behavioural disorders, and external causes, patterns are more heterogeneous and gender-specific. Notably, neoplasms exhibit RIIs < 1 among women aged 55 and older. Overall, the results highlight widespread income-related inequalities in mortality in Spain and underscore the need to prioritise lower-income groups in public health efforts, particularly regarding chronic and behavioural health conditions.
PMID:42228219 | DOI:10.1007/s10198-026-01943-2
