Temporal trends in cardiometabolic mortality inequalities across Spanish regions, 2008–2023

Background

Cardiometabolic diseases are leading contributors to mortality in Spain. However, temporal trends in subnational inequalities remain underexplored. We aimed to assess trends in regional inequalities in cardiometabolic disease mortality across Spanish autonomous communities (regions) from 2008 to 2023.

Methods

Longitudinal observational study of population data from Spain’s National Statistics Institute. Age-standardised death rates by sex, region, and cause (ICD-10 circulatory, endocrine-metabolic chapters) were estimated. Using robust weighted least squares regression with sensitivity checks, we estimated absolute and relative slope indices of inequality (SII, RII), taking the Multidimensional Quality of Life Index (IMCV) as predictor. Temporal trends were analysed via linear regression models.

Results

Mean mortality rates were higher in men than in women for both circulatory and endocrine-metabolic causes (184 vs. 142 deaths per 100,000; p < 0.001). For circulatory mortality, absolute inequality in 2008 favoured men in high-IMCV regions (SII = –41 deaths/100,000), but this gradient attenuated over time (annual change: –1 death/100,000; p = 0.03). Relative inequalities also declined (RII: 1.12 to 1.10; p < 0.03). Conversely, women in low-IMCV regions faced 7% higher relative inequality than men (RII 1.17 vs. 1.10; p < 0.01). Endocrine-metabolic inequality trends were not statistically significant.

Conclusions

Regional inequalities in circulatory mortality have narrowed over time in men, but relative gaps persist, particularly among women in low-IMCV regions. These findings highlight the need for sex-, cause-, and region-sensitive equity-oriented surveillance frameworks integrating inequality measures to better inform targeted public health policies.

Key messages

• Spain’s absolute inequality in circulatory mortality fell 21/100,000 for male residents of high-IMCV regions.

• Women residing in low-IMCV regions had 7% higher relative inequality in circulatory mortality; equity-oriented surveillance is key.