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However, the relationship between income and specific causes of death (CoD) remains insufficiently explored. This study examines socioeconomic inequalities in cause-specific mortality in Spain, simultaneously accounting for CoD, age, sex, and income. To the best of our knowledge, no previous study has jointly combined all these variables. Using data for the entire population residing in Spain from 2010 to 2019, we compute death rates by CoD, age, sex, and income decile by linking individual demographic records with census tract-level disposable income. The analysis covers 4\u00a0million deaths and over 466\u00a0million person-years at risk. Robust income-based relative risks and gradients by CoD are calculated for five-year age groups, stratified by sex, while Relative Index of Inequality (RII) values are derived for single years of age. Results show strong and consistent income-related inequalities in mortality across age, CoD, and sex, especially among younger and middle-aged groups. Particularly steep and significant gradients are found for circulatory, respiratory, digestive, infectious, endocrine, and genitourinary diseases, as well as for symptoms and abnormal findings, and other conditions, with lower-income individuals facing markedly higher risks. For neoplasms, nervous, mental and behavioural disorders, and external causes, patterns are more heterogeneous and gender-specific. Notably, neoplasms exhibit RIIs\u2009&lt;\u20091 among women aged 55 and older. Overall, the results highlight widespread income-related inequalities in mortality in Spain and underscore the need to prioritise lower-income groups in public health efforts, particularly regarding chronic and behavioural health conditions.<\/jats:p>","DOI":"10.1007\/s10198-026-01943-2","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:17:30Z","timestamp":1780391850000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The socioeconomic gradient in mortality by cause of death, age and sex in Spain"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7475-8549","authenticated-orcid":false,"given":"Josep","family":"Lled\u00f3","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0129-726X","authenticated-orcid":false,"given":"Jose M.","family":"Pav\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"1943_CR1","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1098\/rstl.1825.0026","volume":"115","author":"B Gompertz","year":"1825","unstructured":"Gompertz B.: On the nature of the function expressive of the law of human mortality, and on a new mode of determining the value of life contingencies. 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Urban Sci. 5(2), 45 (2021). https:\/\/doi.org\/10.3390\/urbansci5020045","journal-title":"Urban Sci."}],"container-title":["The European Journal of Health Economics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10198-026-01943-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10198-026-01943-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10198-026-01943-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T21:02:54Z","timestamp":1780434174000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10198-026-01943-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":49,"alternative-id":["1943"],"URL":"https:\/\/doi.org\/10.1007\/s10198-026-01943-2","relation":{},"ISSN":["1618-7598","1618-7601"],"issn-type":[{"value":"1618-7598","type":"print"},{"value":"1618-7601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"assertion":[{"value":"11 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study did not require approval from a research ethics committee, as it is based exclusively on the secondary analysis of anonymised administrative data, population and mortality data provided by the Spanish National Statistics Institute (Instituto Nacional de Estad\u00edstica, INE). The data were accessed under a formal research agreement (project BE092-093-2021, Efectos Sociales y Econ\u00f3micos de las Fluctuaciones Intra-anuales en los Eventos Demogr\u00e1ficos), and their use is subject to strict confidentiality and statistical secrecy requirements. All data were provided in a de-identified format, and no personally identifiable information was available to the researchers. The analyses were conducted in accordance with applicable data protection regulations, and all results are presented in aggregated form to ensure confidentiality.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Ethics approval"}},{"value":"Demographic microdata were provided by INE\n                      \n                      under reasonable research-oriented request and payment in advance. The estimated raw and smoothed death rates by cause of death, income decile, age and sex are available in the supplementary material. INE is not responsible for the results or the conclusions drawn from the use of its data. The degree of accuracy and reliability of the computations made by the authors is their sole responsibility.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data sharing"}},{"value":"The authors report there are no competing interests to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Competing Interests"}}]}}