Smoking among Spanish women has increased during the last 50 years and is considered by some authors a modern epidemic. However, mortality risk by cohorts may differ at a regional level, given that health inequalities (and the determinants of smoking and its consequences) are regionally patterned. We applied an Age-Period-Cohort model to identify birth cohort effects on female lung cancer mortality in Spain. We found a strong linear increase in lung cancer mortality during the 1980–2019 period in all regions. Cohorts born between 1935 and 1955 presented a higher relative risk of death at a national and subnational level. However, we found diverging cohort patterns across regions afterward, with some regions presenting a slight mortality improvement (or stagnation) in their youngest cohorts, while in other regions mortality kept increasing. This suggests that inequalities in lung cancer mortality in Spain among women are not only generationally based, but that generational risks also vary across space. Some of the regions that presented improvements in mortality among its younger cohorts are Madrid, Navarra, and the Basque Country, which are some of the wealthiest in the Country. While speculative, this could imply that improvements at a regional level might be associated with factors related to structural conditions that result in the adoption of healthy behaviors.

过去 50 年来，西班牙女性吸烟人数有所增加，一些作者认为这是一种现代流行病。然而，鉴于健康不平等（以及吸烟的决定因素及其后果）具有区域性模式，不同人群的死亡风险在区域层面可能有所不同。我们应用年龄-时期-队列模型来确定出生队列对西班牙女性肺癌死亡率的影响。我们发现 1980 年至 2019 年期间，所有地区的肺癌死亡率均呈显着线性增长。 1935 年至 1955 年间出生的人群在国家和国家以下各级呈现出较高的相对死亡风险。然而，我们随后发现各地区的队列模式存在差异，一些地区最年轻队列的死亡率略有改善（或停滞），而其他地区的死亡率则持续上升。这表明西班牙女性肺癌死亡率的不平等不仅存在代际差异，而且代际风险也因空间而异。年轻人死亡率有所改善的一些地区包括马德里、纳瓦拉和巴斯克地区，这些地区是该国最富裕的地区之一。虽然是推测性的，但这可能意味着区域层面的改善可能与导致采取健康行为的结构条件相关的因素有关。