Beyond the underlying cause of death: an algorithm to study multi-morbidity at death.

Background: In countries with high life expectancy, a growing share of the population is living with several diseases, a situation referred to as multi-morbidity. In addition to health data, cause-of-death data, based on the information reported on death certificates, can help monitor and characterize this situation. This requires going beyond the underlying cause of death and accounting for all causes on the death certificates which may have played various roles in the morbid process, depending on how they relate to each other.

Deciphering the sex gap in global life expectancy: the impact of female-specific cancers 1990-2019.

Background: Females live longer than males, which results in a sex gap in life expectancy. This study examines the contribution of female cancers to this differential by world region and country over the period 1990-2019 with special focus to the 15-69 years age group.

Methods: Cause-specific mortality data for 30 cancers, including 4 female-specific cancers from 238 countries and territories, were retrieved from the Global Burden of Disease Study 2019.

[DDHealth Protocol: Justification, design and implementation of a cross-sectional survey of sociodemographic health, health literacy and digital divide in 2,000 adults aged fifty to seventy-nine residing in Spain in 2022].

Socioeconomic inequalities in health persist in Spain. The DDHealth project aims to address two timely innovative aspects that have been postulated to contribute to socioeconomic inequalities in health. DDHealth aims to address two innovative and timely aspects that have been proposed to contribute to socioeconomic health inequalities.

Frailty at death: An examination of multiple causes of death in four low mortality countries in 2017.

Background: The increasing prevalence of frailty in aging populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process.

Objective: To examine frailty-related mortality as reported on the death certificate in France, Italy, Spain and the United States in 2017.

Methods: We identify frailty at death for the population aged 50 years and over in France, Italy, Spain and the United States.

Age and cause-of-death contributions to educational inequalities in life expectancy and lifespan variation in a low-mortality country: A cross-sectional study of 1.67 million deaths in Spain (2016-19).

Background: We aim to assess the age- and cause-specific contributions to differences in life expectancy and lifespan variation between the high- and low-educated groups in Spain.

Methods: We use sex-, age-, education- and cause-specific mortality and population data for individuals aged 30 and over for 2016-19 in Spain. We estimated life expectancies, and standard deviations of the age-at-death distribution (lifespan variation), and we disentangled the contribution of age-causes of death to educational differences in both indicators.

Healthy lifespan inequality: morbidity compression from a global perspective.

Current measures of population health lack indicators capturing the variability in age-at-morbidity onset, an important marker to assess the timing patterns of individuals' health deterioration and evaluate the compression of morbidity. We provide global, regional, and national estimates of the variability in morbidity onset from 1990 to 2019 using indicators of healthy lifespan inequality (HLI). Using data from the Global Burden of Disease Study 2019, we reconstruct age-at-death distributions to calculate lifespan inequality (LI), and age-at-morbidity onset distributions to calculate HLI.

Cause-specific mortality in Spain during the pandemic: educational differences and its impact on life expectancy.

Background: Life expectancy in Spain fell by 1 year between 2018/19 and 2020. Yet, little is known on the impact on cause-of-death (COD) dynamics and educational inequalities therein.

Methods: We use individual-level death counts data by age, sex, education and multiple causes of death (MCOD) and the corresponding population exposures from national registers in Spain.

Alcohol-related mortality in four European countries: A multiple-cause-of-death study.

Introduction: The impact of conditions that partly or indirectly contribute to drinking-related mortality is usually underestimated. We investigate all alcohol-related multiple (underlying and contributory) causes of death and compare mortality distributions in countries with different levels and patterns of drinking.

Method: Analysis of population-level mortality data for persons aged 20 and over in Austria, Czechia, Poland and Spain.

Cause-of-Death Diversity From a Multiple-Cause Perspective in the United States.

Cause-of-death diversity captures the variability of deaths across causes and is an important marker of heterogeneity in a population's health. We contribute to the debate of cause-of-death diversity dynamics by following a novel multiple causes of death (MCOD) approach and applying it to the U.S.

Estimation of smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain: an observational study, 2016-2019.

Objective: To estimate smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain.

Design: Nationwide, observational study from 2016 to 2019. Population-attributable fractions were used to estimate age, sex and education-specific cause-of-death smoking-attributable mortality.

Socioeconomic inequalities in physiological risk biomarkers and the role of lifestyles among Russians aged 35-69 years.

Background: Socioeconomic inequalities in cardiovascular (CVD) health outcomes are well documented. While Russia has one of the highest levels of CVD mortality in the world, the literature on contemporary socio-economic inequalities in biomarker CVD risk factors is sparse. This paper aims to assess the extent and the direction of SEP inequalities in established physiological CVD risk biomarkers, and to explore the role of lifestyle factors in explaining SEP inequalities in physiological CVD risk biomarkers.

Educational differences in alcohol-related mortality and their impact on life expectancy and lifespan variation in Spain (2016-2018): a cross-sectional analysis using multiple causes of death.

Background: Socioeconomic inequalities in alcohol-related mortality in Spain exists, and are postulated to contribute to inequalities in all-cause mortality. We aim to assess absolute and relative educational inequalities in alcohol-related mortality, and to estimate the role of alcohol in educational inequalities in both life expectancy and lifespan variation in Spain.

Methods: We used multiple cause-of-death (MCOD) mortality data for individuals aged 30 and over for Spain (2016-2018) by educational attainment.

The combined impact of smoking, obesity and alcohol on life-expectancy trends in Europe.

Background: Smoking, obesity and alcohol abuse greatly affect mortality and exhibit a distinct time dynamic, with their prevalence and associated mortality rates increasing and (eventually) declining over time. Their combined impact on secular trends in life expectancy is unknown but is relevant for understanding these trends. We therefore estimate the combined impact of smoking, obesity and alcohol on life-expectancy trends in Europe.

Past and Future Alcohol-Attributable Mortality in Europe.

Although alcohol consumption is an important public health issue in Europe, estimates of future alcohol-attributable mortality for European countries are rare, and only apply to the short-term future. We project (age-specific) alcohol-attributable mortality up to 2060 in 26 European countries, after a careful assessment of past trends. For this purpose we used population-level country-, sex-, age- (20-84) and year-specific (1990-2016) alcohol-attributable mortality fractions (AAMF) from the Global Burden of Disease (GBD) study, which we adjusted at older ages.

Quantifying the contribution of established risk factors to cardiovascular mortality differences between Russia and Norway.

Surprisingly few attempts have been made to quantify the simultaneous contribution of well-established risk factors to CVD mortality differences between countries. We aimed to develop and critically appraise an approach to doing so, applying it to the substantial CVD mortality gap between Russia and Norway using survey data in three cities and mortality risks from the Emerging Risk Factor Collaboration. We estimated the absolute and relative differences in CVD mortality at ages 40-69 years between countries attributable to the risk factors, under the counterfactual that the age- and sex-specific risk factor profile in Russia was as in Norway, and vice-versa.

Monitoring life expectancy levels during the COVID-19 pandemic: Example of the unequal impact of the first wave on Spanish regions.

Background: To provide an interpretable summary of the impact on mortality of the COVID-19 pandemic we estimate weekly and annual life expectancies at birth in Spain and its regions.

Methods: We used daily death count data from the Spanish Daily Mortality Monitoring System (MoMo), and death counts from 2018, and population on July 1st, 2019 by region (CCAA), age groups, and sex from the Spanish National Statistics Institute. We estimated weekly and annual (2019 and 2020*, the shifted annual calendar period up to 5 July 2020) life expectancies at birth as well as their differences with respect to 2019.

Future Alcohol-Attributable Mortality in France Using a Novel Generalizable Age-Period-Cohort Projection Methodology.

Aim: To forecast age- and sex-specific alcohol-attributable mortality in France for the period 2015-2050 using a novel generalizable methodology that includes different scenarios regarding period and cohort change.

Methods: For the French national population aged 25-90 years (1979-2014), we estimated alcohol-attributable mortality by mortality from the main causes of death wholly attributable to alcohol, plus liver cirrhosis mortality. We modelled sex-specific alcohol-attributable mortality by adjusting for age, period and birth cohort.

Alcohol and educational inequalities: Hazardous drinking prevalence and all-cause mortality by hazardous drinking group in people aged 50 and older in Europe.

Background: We examined educational inequalities in hazardous drinking prevalence among individuals aged 50 or more in 14 European countries, and explored educational inequalities in mortality in hazardous drinkers in European regions.

Unlabelled: We analyzed data from waves 4, 5 and 6 of the Survey of Health Ageing and Retirement in Europe (SHARE). We estimated age-standardized hazardous drinking prevalence, and prevalence ratios (PR) of hazardous drinking by country and educational level using Poisson regression models with robust variance.