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The cost of inequality: income and life expectancy at birth in Spain
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DOI：10.1016/j.healthpol.2026.105616.png)
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Abstract
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Background: Despite the well-recognized relationship between income and life expectancy, much of the existing evidence is indirect, relying on cross-country comparisons, statistical modeling, analyses beginning at older ages, or data limited to a small number of specific socioeconomic groups. Objective: To examine life expectancy at birth across the entire Spanish population using up to one hundred income groups and to analyze its variation by income level during the austerity period following the Great Recession. Methods: The study adopts a whole-population microdata ecological approach and employs five-year rolling death rate estimators to construct life tables by income group and sex in Spain from 2012 to 2017. The computations, which involve over 14 billion person-year observations, are based on a dataset comprising 520 million unique demographic events recorded over a ten-year period. Results: Life expectancy at birth increases progressively with income percentile, with differences between the poorest and richest groups exceeding 8 years among men and 5 years among women. The gap between the highest- and lowest-income groups widened during the austerity period under study, indicating a growing disparity. Conclusions: These findings support the view that economic conditions are closely linked to mortality risk and underscore the importance of social policies. They also suggest that addressing income-related health disparities through targeted interventions and public healthcare spending may reduce inequalities across social groups and yield substantial gains in life expectancy.
Keywords:
Big microdata
Social policies
Ecological imputation
Contextual wealth
Life tables
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