Pharmaceutical spending linked to lower treatable deaths in Spain

Increases in Spanish government spending on retail pharmaceuticals were associated with short-term declines in mortality from causes most responsive to medical care, according to a study published in BMC Medicine. The research, led by Julieta Politi and colleagues, analysed annual data from Spain’s 17 autonomous regions between 2001 and 2019 to estimate how year-to-year changes in public pharmaceutical expenditure tracked changes in death rates.

They also separated premature deaths, occurring before age 75, from deaths at age 75 or older, and broke results down by cause groups including circulatory diseases, cancers, respiratory diseases, infectious diseases and other causes.

Methodologically, the study used a cross-sectional time series design with weighted log-log first-difference regression adjusted for relevant covariates. The resulting estimates were mortality elasticities with respect to government expenditure on retail pharmaceuticals (GERP) and government expenditure on other health goods and services (GEOH), each interpreted as the percentage change in a mortality rate associated with a 1% increase in the two-year mean change in expenditure.

For pharmaceutical spending, the significant negative elasticities were concentrated in the categories most sensitive to treatment. Premature treatable mortality showed an elasticity of −0.23%, meaning a 1% increase in the two-year mean change in GERP was associated with a 0.23% lower rate. By cause group, premature mortality fell by 0.56% for respiratory causes, 0.49% for infectious causes and 0.22% for circulatory causes per 1% increase in spending.

Similar patterns appeared among older adults. Non-premature treatable mortality showed an elasticity of −0.20%, while non-premature mortality from infectious causes fell by 0.66% and from respiratory causes by 0.50% per 1% increase in pharmaceutical expenditure. When the researchers stratified jointly by avoidability and cause group, the largest inverse associations were seen for premature treatable mortality from infectious causes, at −1.60%, and from respiratory causes, at −0.88%.

By contrast, the associations for government expenditure on other health goods and services were generally weaker and statistically nonsignificant, with exceptions such as non-premature mortality from circulatory causes, particularly when GEOH was measured with a one-year lag. This asymmetry suggests that, within the short time frame studied, changes in pharmaceutical spending showed a clearer statistical relationship with treatable mortality than changes in other health spending.

The study also included a sensitivity analysis covering 2001 to 2013 in which the models were additionally adjusted for government social expenditure. In that sub-analysis, the negative elasticities for non-premature mortality with respect to pharmaceutical spending weakened considerably, indicating that some of the association among older adults may reflect broader social spending patterns rather than pharmaceutical expenditure alone.

The authors conclude that short-term changes in government expenditure on retail pharmaceuticals were inversely associated with changes in premature mortality, particularly from treatable causes, especially respiratory and infectious ones, while for non-premature mortality the associations attenuated after adjustment for social expenditure. The study is an observational, ecological analysis of regional aggregate data, so the elasticities describe population-level associations over short periods and cannot establish that spending changes caused the mortality changes in individuals.

As the authors note, specific studies on the relationship between pharmaceutical expenditure and mortality are sparse, particularly those that consider mortality from causes most sensitive to medical treatments. The findings add to that limited evidence base by quantifying short-term associations in a country with regional variation in health spending, while the published version of the article remains subject to the final Version of Record edits.

Subject of Research: Short-term associations between government pharmaceutical expenditure and avoidable mortality in Spain

Article Title: Short-term inverse association between changes in government expenditure on retail pharmaceuticals and treatable mortality in Spain

Article References: Politi, J., Donat, M., Regidor, E., Pastor-Barriuso, R., Sordo, L., Gonzalez-Recio, P., Moreno, A., Belza, M. J., & Barrio, G. (2026). Short-term inverse association between changes in government expenditure on retail pharmaceuticals and treatable mortality in Spain. BMC Medicine. https://doi.org/10.1186/s12916-026-05338-1

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05338-1

Keywords: pharmaceutical expenditure, treatable mortality, Spain, public health spending, mortality elasticity, premature mortality, respiratory diseases, infectious diseases, health economics, BMC Medicine, time series analysis, avoidable mortality