Changes in drug and alcohol-related mortality by educational status during the 2008-2011 economic crisis: Results from a Spanish longitudinal study.
Abstract Introduction The objective was to assess changes in drug- and alcohol-related mortality by educational attainment during the last financial crisis in Spain Methods Data came from the 2001 Census Longitudinal Study. We included 22.2 million residents in Spain aged ≥35 at census date followed-up until December 2011. Outcomes were drug-related mortality (DRM) and deaths directly attributable to alcohol (DDA). Mortality risks before and during the crisis were assessed using age-standardized rates and educational inequalities by estimating age-adjusted Rate Ratios (RR) and Relative Indexes of inequality (RII) between educational groups. Results During the first four year of the crisis, DRM and DDA in men and women increased in all educational subgroups except for DRM in men with tertiary studies (-15%). The increase in mortality was larger in those with higher educational status, with women with tertiary studies experiencing the largest increases in DRM (+100%) and DDA (+116%). Mortality risks for both outcomes followed an educational gradient before and during the crisis in men and women, with those with primary studies being at higher risk. Absolute and relative measures of inequality decreased during the crisis, except for DRM in men. Conclusions DRM and DDA follow an inverse educational gradient, with those with primary studies being at higher risk. During the last financial crisis, DRM decreased only in men with tertiary studies, with DRM and DDA increasing in all other groups. The increase was larger in those with higher educational status, reducing inequalities in all groups except of DRM in men.