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Gac Sanit. 2020 Jan 23. pii: S0213-9111(19)30261-4. doi: 10.1016/j.gaceta.2019.11.001. [Epub ahead of print]

Effect of the recent economic crisis on socioeconomic inequalities in mortality in nine urban areas in Europe.

Author information

1
Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain. Electronic address: lpalenci@aspb.cat.
2
Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
3
Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Kosice, Slovak Republic; Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czech Republic.
4
Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden.
5
Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal.
6
Interface Demography, Section Social Research, Vrije Universiteit Brussels, Brussels, Belgium.
7
Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic.
8
Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
9
Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal; Department of Geography and Tourism, Humanities Faculty, University of Coimbra, Coimbra, Portugal.

Abstract

OBJECTIVE:

To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis.

METHOD:

This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The units of analysis were the small areas of nine European urban areas. We used a composite deprivation index as a socioeconomic indicator, along with other single indicators. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyse the evolution of socioeconomic inequalities, we fitted an ecological regression model that included the socioeconomic indicator, the period of time, and the interaction between these terms.

RESULTS:

We observed significant inequalities in mortality among men for almost all the socioeconomic indicators, periods, and urban areas studied. However, no significant changes occurred during the period of the economic crisis. While inequalities among women were less common, there was a statistically significant increase in inequality during the crisis period in terms of unemployment and the deprivation index in Prague and Stockholm, respectively.

CONCLUSIONS:

Future analyses should also consider time-lag in the effect of crises on mortality and specific causes of death, and differential effects between genders.

KEYWORDS:

All-cause mortality; Crisis económica; Desigualdades socioeconómicas; Economic crisis; Europa; Europe; Mortalidad por todas las causas; Small areas; Socioeconomic inequalities; Áreas pequeñas

PMID:
31983478
DOI:
10.1016/j.gaceta.2019.11.001
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