title: Educational differences in mortality and the relative importance of different causes of death: a 7-year follow-up study of Spanish adults.
abstract: BACKGROUND
  The evidence on mortality patterns by education in Spain comes from regional areas. This study aimed to estimate these patterns in the whole Spanish population.
  
  
  METHODS
  All citizens aged 25 years and over and residing in Spain in 2001 were followed during 7 years to determine their vital status, resulting in a total of 196,470,401 person-years and 2,379,558 deaths. We estimated the age-adjusted total and cause-specific mortality by educational level-primary, lower secondary, upper secondary and university education-and then calculated the relative and absolute measures of inequality in mortality and contribution of the leading causes of death to absolute inequalities.
  
  
  RESULTS
  Except for some cancer sites, the mortality rate for the leading causes of death shows an inverse gradient with educational level. The leading causes of death with the highest relative index of inequality ratios were HIV disease (9.81 in women and 11.61 in men), diabetes in women (4.02) and suicide in men (3.52). The leading causes of death that contribute most to the absolute inequality in mortality are cardiovascular diseases (48.8%), respiratory diseases (9.3%) and diabetes mellitus (8.8%) in women, and cardiovascular diseases (20.8%), respiratory diseases (19.8%) and cancer (19.6%) in men.
  
  
  CONCLUSIONS
  Although the causes of death with the strongest gradient in mortality rate are HIV disease in both sexes, diabetes mellitus in women and suicide in men, most of the absolute education-related inequalities in total mortality are due to cardiovascular diseases, respiratory diseases and diabetes mellitus in women and to cardiovascular diseases, respiratory diseases and cancer in men.
authors.affiliation: National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Reques
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Giráldez-García
authors.affiliation: Department of Sociology, Health Sociology, Universidad Pública de Navarra, Madrid, Spain.
authors.forename: Estrella
authors.initials: E
authors.lastname: Miqueleiz
authors.affiliation: National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Belza
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000401:mortality; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000401:mortality; D012140:Respiratory Tract Diseases / Q000401:mortality; D013030:Spain / Q000453:epidemiology
keywords: EDUCATION; EPIDEMIOLOGY; Health inequalities; MORTALITY; SOCIAL EPIDEMIOLOGY