Trends in cause-specific mortality: deaths of despair in Spain, 1980–2019

BACKGROUND: Research from various countries has shown increases in alcohol- and drug-related deaths and suicide, known as ‘deaths of despair’ over recent decades, particularly among low-educated middle-aged individuals. However, little is known about trends in death-of-despair causes in Spain. Therefore, we aim to descriptively examine this among 25–64-year-olds from 1980 to 2019 and by educational attainment for the years 2017–19. METHODS: We obtained mortality and population data from the National Institute of Statistics to estimate age-standardized mortality rates and assess educational inequalities using the relative index of inequality (RII). RESULTS: Deaths of despair as a share of total mortality slightly increased from 2000 onwards, particularly among 25–64-year-old men (from 9 to 10%). Only alcohol-related mortality declined relatively more since 1980 compared with all-cause mortality. Regarding educational differences, low-educated men presented higher mortality rates in all death-of-despair causes (alcohol-related: RII 3.54 (95% CI: 2.21–5.66); drug-related: RII 3.49 (95% CI: 1.80–6.77); suicide: RII 1.97 (95% CI: 1.49–2.61)). Women noteworthy differences were only observed for alcohol-related (RII 3.50 (95% CI: 2.13–5.75)). CONCLUSIONS: Findings suggest an increasing proportion of deaths of despair among 25–64-year-olds since 2000, particularly among men. Public health policies are needed to reduce and prevent these premature and preventable causes of mortality.