A Few Years of Difference in Life Expectancy Between Poorest and Wealthiest in Spain
Wealth, and the closely related construct of socioeconomic status, correlate with life expectancy. Wealth also correlates with environmental exposure to air pollution, as wealthier people tend to live in better surroundings, intelligence, education, access to and effective use of medical services, lifestyle choices that impact health, and a range of other line items that are also correlate with life expectancy.
Picking out the important mechanisms that directly impact long-term health and mortality risk is a challenge, for all that it is tempting to point to the obvious candidates of excess weight and smoking habits, both of which are individually accompanied by a great deal of evidence for the size of effect and strength of correlation. There are always other mechanisms! Intelligence is suggested to have genetic contributions that overlap with those determining physical robustness, for example.
This is the usual story in human epidemiology: correlations abound, but identifying actionable, harmful mechanisms for intervention is difficult. There is a very good mechanistic argument that reducing particulate air pollution will reduce chronic inflammation and cardiovascular mortality. But is that a significant contribution in comparison to the choice to smoke, or the choice to become obese? Individuals can look at the research and make sensible choices in an environment of uncertainty surrounding the details, to the best of their ability, and that may be all that can come of it at the end of the day.
Life tables summarise a population's mortality experience during a time period. Sex- and age-specific life tables are needed to compute various cancer survival measures. However, mortality rates vary according to socioeconomic status. We present sex- and age-specific life tables based on socioeconomic status at the census tract level in Spain during 2011-2013 that will allow estimating cancer relative survival estimates and life expectancy measures by socioeconomic status.
Life expectancy (LE) at birth was higher among women than among men. Women and men in the most deprived census tracts in Spain lived 3.2 and 3.8 years less than their counterparts in the least deprived areas. Overall, we found a consistent LE gap at birth according to socioeconomic status for both sexes in Spain during the 2011-2013 period. However, the gap was wider among men than among women, with the least deprived male group experiencing shorter LE at birth than the most deprived female group. Furthermore, we found a geographical pattern characterised by shorter LE at birth in the southwest for both sexes in Spain.
Furthermore, our results on LE at birth by deprivation are consistent with those of other European studies. In the UK, LE at birth in 2005 presented a similar pattern, with the highest LE in the most affluent groups compared to the most deprived group, with a gap between 2.7 and 5.0 years for males and between 2.5 and 3.6 years for females. Overall, differences in LE are seen by deprivation and by region, and the regions with higher LE are also the least deprived. Similar to the geographical pattern found in Spain, a regional pattern characterised by a clear north-south gradient was found in the UK, with deprivation explaining most of the geographical variation in LE.