Educational differences in alcohol-related mortality in Spain using multiple causes of death

Abstract

Abstract Background Socioeconomic inequalities in alcohol-attributable mortality are commonly studied using only underlying causes of death (UCOD). We aim to assess absolute and relative educational inequalities in alcohol-related mortality, and to estimate the role of alcohol in educational inequalities in both life expectancy and lifespan variation in Spain. Methods We used multiple cause-of-death (MCOD) mortality data for individuals aged 30 and over for Spain (2016-18) by educational attainment. We estimated by sex and educational attainment age-standardized alcohol-attributable mortality rates, relative and absolute indices of educational inequalities; and total life expectancy and lifespan inequality at age 30 for all-cause mortality and after eliminating alcohol-attributable mortality. Results The use of MCOD resulted in an additional 2,543 annual alcohol-related deaths (+75% among men, and +50% among women) compared to estimates derived from UCOD. In absolute terms, the most unequal age groups were those aged 45-84 among men and 45-65 among women. In relative terms, higher inequalities exist in working ages, whereas at older ages inequalities tended to be lower, although still important among men. Alcohol contributed to educational inequalities in life expectancy (men: 0.13 years (3.2%); women 0.02 years (0.7%)) and lifespan inequalities (2.1% and 1.4% for men and women, respectively). Conclusions Alcohol-related estimates derived from MCOD are more accurate compared to estimates derived from UCOD approaches, although these estimates are still underestimating the impact of alcohol on mortality in Spain. Alcohol remains an important lifestyle to be tackled in order to reduce mortality inequalities. Key messages Alcohol-related mortality estimates using multiple causes of death (MCOD) increased the death counts related to alcohol by 75% among men and 50% among women compared to underlying causes of death. This study confirms the role of alcohol on mortality in both mean indicators (life expectancy) and indicators of age-at-death dispersion (lifespan inequality).