Impact of the great recession on self-perceived health in Spain: a longitudinal study with individual data

Impacto de la crisis económica sobre la percepción de la salud en la población española

Objetivo: analizar el impacto de la situación económica en la percepción del estado de salud y la capacidad explicativa de las características individuales en esta percepción. Método: estudio transversal con enfoque analítico. Se extrajeron datos de la Encuesta Nacional de Salud (ENSE) publicada en 2011-2012 (crisis económica) y en 2017 (recuperación). La variable dependiente fue la percepción de la salud recogida en una escala Likert de 1 (muy bueno) a 5 (muy malo). Las variables independientes fueron: el momento de recogida (crisis/recuperación), sociodemográficas, relacionadas con el estilo de vida, relativas al estado «objetivo» de salud y relacionadas con el uso de servicios. Se construyeron modelos lineales generalizados para dar respuesta a los objetivos. Para valorar la magnitud del tamaño del efecto de las asociaciones se valoró la dispersión de las distribuciones según la relación existente entre el efecto y la desviación estándar de la media (DS). Resultados: se encontró una mejoría en la percepción del estado de salud de -0,066 (intervalo de confianza [IC] 95%: entre -0,080 y -0,052) puntos en el período de recuperación. Se hallaron asociaciones de tamaño del efecto «moderado» entre una peor percepción de salud y las variables relacionadas con el estado «objetivo» de salud; y «pequeño», con las variables relacionadas con el estilo de vida poco saludable y la clase social más desfavorecida. Conclusión: los períodos de crisis económica se asocian a una peor percepción del estado de salud, impactando más en aquella población perteneciente a una categoría social baja, con hábitos de vida poco saludables y especialmente en los pacientes crónicos. Palabras clave: estado de salud, crisis económica, enfermedad crónica, España, clase social, características de la población.

Influence of Gender Determinants on Informal Care and Health Service Utilization in Spain: Ten Years after the Approval of the Equality Law

The existence of gender inequalities in health, in the use of health services, and in the development of informal care has been demonstrated throughout scientific literature. In Spain, a law was passed in 2007 to promote effective equality between men and women. Despite this, different studies have shown that the previous gender inequalities are still present in Spanish society. For all these reasons, the objective of this paper is to study the differences by sex in informal care and in the use of emergency care, and to identify the existence of gender inequalities in Spain 10 years after the adoption of the aforementioned equality law. In this case, we development a cross-sectional study based on the 2017 Spanish National Health Survey of the Spanish population aged 16 and over. To analyze the influence of gender determinants on informal care and emergency care utilization, logistic regressions were performed, model 1 was adjusted for age, and model 2 was further adjusted too by the variables of the Andersen care demand model. The results showed that informal care and the use of the emergency care continues to be higher in women than in men. Informal care in women was related to a higher level of education. In emergency care, the older the age, the lower the probability of utilization, and living in a rural municipality was related to a higher probability of utilization for both sexes. Finally, we concluded that there is still a need for studies that analyze gender inequalities in different contexts, such as the informal care and the use of health services. This is especially relevant in Spain, where economic changes have led to a change in roles, mainly for women, and new management strategies are needed to achieve equity in care and effective equality between men and women.

Lack of Social Support and Its Role on Self-Perceived Health in a Representative Sample of Spanish Adults. Another Aspect of Gender Inequality

Self-perceived health has been used as a good estimator of health status and receiving affection can be a determining factor for good self-perceived health. The aim of the present study was to assess whether lack of social support (measured through Duke scale, which ranges from 11 to 55) was associated with poorer health status measured as self-perceived health, and whether that association was different between women and men. A cross-sectional study was conducted using data from the 2017 Spanish National Health Survey. A descriptive study was performed, and logistic regression models were applied using self-perceived health as a dependent variable. Mean Duke score was 47.6 for men and 47.9 for women (p = 0.016). Moreover, 36.3% of women and 27.6% of men reported poor self-perceived health (p < 0.001). The multivariate analysis revealed that lower scores in Duke-UNC social support scale were associated with poorer health status. That association was higher in women than in men. Poor self-perceived health was also associated with low level of education and obesity, especially among women. There was gender inequality as regards health status associated with lack of social support. These results can help design prevention strategies to improve health.

Socioeconomic inequalities in self-assessed health and mental health in Barcelona, 2001-2016

OBJECTIVE

Previous research has found persistent socioeconomic inequalities in health outcomes at the national level, with different patterns after the economic crisis. However, inequalities in urban areas are also important. This study analyses socioeconomic inequalities in self-assessed health and mental health in the city of Barcelona.

METHOD

Repeated cross-sectional design using quinquennial data from the Barcelona Health Surveys carried out in 2001, 2006, 2011 and 2016 for the population older than 22 years. Robust Poisson regressions models were used to compute socioeconomic gradients and relative (RII) and slope indexes of inequality (SII) by occupational social class, with stratification by sex. RII and SII were also obtained with further adjustment by employment situation.

RESULTS

A consistent socioeconomic gradient was found for all years except for 2011. Relative and absolute inequalities followed a V-shape, showing a drop during the economic crisis but widening thereafter to recover pre-crisis figures for self-assessed health and widening for mental health, in both relative and absolute terms in 2016. Adjustment for employment situation reduces inequalities but a large part of these inequalities remains, with variability across years.

CONCLUSIONS

The lasting effects of the 2008 economic crisis and the austerity programmes imposed since then may have contributed to the persistence of socioeconomic inequalities in self-assessed health and the widening of those for mental health.

Saved by Wealth? Income, Wealth, and Self-Perceived Health in Spain during the Financial Crisis

We evaluate the association between the variations in income and wealth, (both aggregate and split between real estate and financial wealth), and self-perceived health in Spain using a longitudinal sample of individuals before and after the financial crisis. We estimated generalized linear mixed models, with a binomial response and a logistic link, for four waves of the Spanish Survey of Household Finances (two before and two after the crisis), adjusting for variables at the family and individual levels. We also controlled for familial and individual heterogeneity and for temporal trends. While an increase in wealth greatly increases the probability of younger individuals reporting better health, this is not the case for older individuals. Decreases in gross wealth are associated with decreases in the probability of declaring good/very good health only in families whose reference person is over 44 years old. We conclude that: (i) not just income but net wealth effects impact on the consequences of income fluctuations on consumption and health assessed, (ii) the composition of individuals’ net wealth may also matter, since they are differently affected by the shocks in the economic crisis, (iii) age plays a significant role and, finally, (iv) individual reactions in terms of consumption and savings, given any level of income and wealth, according to the risk aversions for precautionary idiosyncratic motives, may also need to be considered in order to complete the picture.