Small socio-economic differences in mortality in Spanish older people

Background: Previous studies found smaller mortality inequalities in Southern Europe than in other European populations. This study used a sample of older Spanish adults to identify possible factors explaining these findings. Methods: A cohort of 4008 persons aged epsilon 60 years was selected in 2000-01 and followed prospectively until 2008. At baseline, data were collected on education, occupation and major mortality risk factors: social network, lifestyles, diet, obesity and hypertension. Analyses were conducted with Cox regression, and adjusted for the risk factors at baseline. Results: The hazard ratio (HR) and 95% confidence interval (95% CI) for mortality adjusted for age, marital status, region and place of residence in people with low vs. high educational level was 1.13 (0.86-1.50) in men and 1.23 (0.83-1.80) in women. The HR in the manual vs. non-manual occupational class was 0.92 (0.74-1.15) in men and 1.07 (0.86-1.33) in women. Adjustment for the different risk factors decreased or did not change the HR. After full adjustment for all risk factors the mortality HR in those with low education was 0.99 (0.74-1.32) in men and 1.18 (0.80-1.76) in women, while the mortality HR in the manual occupational class was 0.85 (0.68-1.06) in men and 1.04 (0.83-1.30) in women. Conclusions: From a European perspective, mortality inequalities in Spanish older adults are small. The ubiquitous presence of social networks and the widespread adherence to the Mediterranean diet may be responsible for this finding.