European Journal of Epidemiology

, Volume 30, Issue 8, pp 637–648 | Cite as

Low mortality in the poorest areas of Spain: adults residing in provinces with lower per capita income have the lowest mortality

  • Enrique RegidorEmail author
  • Fernando Vallejo
  • Carolina Giráldez-García
  • Paloma Ortega
  • Juana M. Santos
  • Paloma Astasio
  • Luis de la Fuente


The objective of this study is to ascertain whether income inequality and per capita income of area of residence show a relationship with mortality in Spain. Data are from a nation-wide prospective study with a 7-year mortality follow-up covering all persons living in Spain’s 50 provinces in 2001. In total 28,944,854 subjects aged 25 years or over at baseline were studied. Rate ratio for total mortality and cause-specific mortality, according to provincial income inequality and per capita income in two age groups, 25–64 years (adult population) and 65 years and over (elderly population). Provincial income inequality was not related to total mortality or cause-specific mortality. Total mortality rate ratios among residents of the poorest versus the richest provinces were 0.89 (95 % CI 0.95–0.93) in men and 0.91 (0.87–0.96) in women, among the adult population; and 1.02 (0.97–1.08) in men and 1.08 (1.02–1.16) in women, among the elderly population. With the exception of cardiovascular-disease mortality for which no association with per capita income was observed, adult residents of the poorest provinces registered the lowest mortality rate ratio for other causes of death. Elderly residents of the poorest provinces registered the highest mortality rate ratio for cardiovascular disease and the lowest mortality rate ratio for cancer and external causes. Aside from cardiovascular-disease mortality, the lowest mortality for most causes of death was registered by residents of the poorest provinces. Nevertheless, these findings need to be confirmed by similar studies using smaller areas as the unit of analysis.


National prospective study Multilevel study Income inequality Per capita income Mortality Leading causes of death Spain 


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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Enrique Regidor
    • 1
    • 2
    • 3
    Email author
  • Fernando Vallejo
    • 2
    • 4
  • Carolina Giráldez-García
    • 1
    • 3
  • Paloma Ortega
    • 1
    • 3
  • Juana M. Santos
    • 1
    • 3
  • Paloma Astasio
    • 1
    • 3
  • Luis de la Fuente
    • 2
    • 4
  1. 1.Department of Preventive Medicine and Public Health, Faculty of MedicineUniversidad Complutense de MadridMadridSpain
  2. 2.CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
  3. 3.Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridSpain
  4. 4.National Epidemiology CenterInstituto de Salud Carlos IIIMadridSpain

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