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There is little information on the evolution of this SEP gradient and its relationship with the economic cycle. Some results suggest that during economic expansions, there is a hypersensitivity of low\u2010SEP people to harmful drinking. The main objective of this study was to measure the evolution of educational inequality in alcohol\u2010related and non\u2010alcohol related mortality by sex and age group in Spain during 2012\u201319.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting and Measurements<\/jats:title><jats:p>This is a repeated cross\u2010sectional study. This study includes all residents in Spain aged 25\u2009years and over from 2012 to 2019. (1) We calculated age\u2010standardized mortality rates (ASMRs) from strongly\/moderately alcohol\u2010related causes (directly alcohol\u2010attributable, unspecified liver cirrhosis, liver and upper aerodigestive tract cancers and moderately alcohol\u2010related), weakly alcohol\u2010related causes and other causes by educational level. (2) We used age\u2010adjusted relative index of inequality (RII) and slope index of inequality (SII) to measure relative and absolute educational inequality in mortality, respectively. (3) Age\u2010adjusted annual percentage change (APC) was also used to measure linear trends in mortality by educational level. RII, SII and APC were obtained from negative binomial regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Between 2012\u201315 and 2016\u201319, economic growth accelerated, the RII in mortality from strongly\/moderately alcohol\u2010related causes increased from 2.0 to 2.2 among men and from 1.1 to 1.3 among women, and the SII in deaths\/100\u2009000 person\u2010years from 181.4 to 190.9 among men and from 18.9 to 46.5 among women. It also increased relative and absolute inequality in mortality from weakly alcohol\u2010related and other causes of death in both men and women. These increases in inequality were due primarily to a flattening or even reversal of the downward mortality trend among low\u2010 and medium\u2010educated people.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>During the economic expansion of 2012\u201319 in Spain, changes in mortality risk from strongly\/moderately alcohol\u2010related causes were especially unfavourable among low\u2010 and medium\u2010educated people.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16264","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T10:05:45Z","timestamp":1684490745000},"page":"1920-1931","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Increase in educational inequalities in alcohol\u2010related mortality in Spain during a period of economic growth"],"prefix":"10.1111","volume":"118","author":[{"given":"Marta","family":"Donat","sequence":"first","affiliation":[{"name":"National School of Public Health Carlos III Health Institute  Madrid Spain"},{"name":"Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Regidor","sequence":"additional","affiliation":[{"name":"Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP)  Madrid Spain"},{"name":"Department of Public Health and Maternal and Child Health, Faculty of Medicine Universidad Complutense  Madrid Spain"},{"name":"Health Research Institute of San Carlos (IdISSC)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6257-3213","authenticated-orcid":false,"given":"Gregorio","family":"Barrio","sequence":"additional","affiliation":[{"name":"National School of Public Health Carlos III Health Institute  Madrid Spain"},{"name":"Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Ambrosio","sequence":"additional","affiliation":[{"name":"Department of Psychobiology, Faculty of Psychology National University of Distance Education (UNED)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Sordo","sequence":"additional","affiliation":[{"name":"Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP)  Madrid Spain"},{"name":"Department of Public Health and Maternal and Child Health, Faculty of Medicine Universidad Complutense  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6708-3291","authenticated-orcid":false,"given":"Juan 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