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

• Published in: Addiction (Abingdon, England) England), 2023-10, Vol.118 (10), p.1920-1931
• Main Authors: Donat, Marta, Regidor, Enrique, Barrio, Gregorio, Ambrosio, Emilio, Sordo, Luis, Guerras, Juan Miguel, Politi, Julieta, Belza, María J.
• Format: Article
• Language: English
• Subjects: Academic achievement; Adenomatous polyposis coli; Age; Alcohol; Alcohol related mortality; Alcohol use; Alcoholism; Business cycles; Cancer; Causes; Change agents; Cirrhosis; Drinking behavior; economic expansion; Economic growth; Educational attainment; Educational inequality; educational level; Hypersensitivity; inequality; Liver; Liver cirrhosis; Mens health; Mortality; Mortality rates; socioeconomic position; Womens health
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/add.16264

Background and aims Alcohol‐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 Measurements This 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. Findings Between 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. Conclusions During 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.