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Piñeiro B, Spijker JJA, Trias-Llimós S, Blanes Llorens A, Permanyer I. Trends in cause-specific mortality: deaths of despair in Spain, 1980-2019. J Public Health (Oxf) 2023; 45:854-862. [PMID: 37491646 PMCID: PMC10687877 DOI: 10.1093/pubmed/fdad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Research from various countries has shown increases in alcohol- and drug-related deaths and suicide, known as 'deaths of despair' over recent decades, particularly among low-educated middle-aged individuals. However, little is known about trends in death-of-despair causes in Spain. Therefore, we aim to descriptively examine this among 25-64-year-olds from 1980 to 2019 and by educational attainment for the years 2017-19. METHODS We obtained mortality and population data from the National Institute of Statistics to estimate age-standardized mortality rates and assess educational inequalities using the relative index of inequality (RII). RESULTS Deaths of despair as a share of total mortality slightly increased from 2000 onwards, particularly among 25-64-year-old men (from 9 to 10%). Only alcohol-related mortality declined relatively more since 1980 compared with all-cause mortality. Regarding educational differences, low-educated men presented higher mortality rates in all death-of-despair causes (alcohol-related: RII 3.54 (95% CI: 2.21-5.66); drug-related: RII 3.49 (95% CI: 1.80-6.77); suicide: RII 1.97 (95% CI: 1.49-2.61)). Women noteworthy differences were only observed for alcohol-related (RII 3.50 (95% CI: 2.13-5.75)). CONCLUSIONS Findings suggest an increasing proportion of deaths of despair among 25-64-year-olds since 2000, particularly among men. Public health policies are needed to reduce and prevent these premature and preventable causes of mortality.
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Affiliation(s)
- Bárbara Piñeiro
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Jeroen J A Spijker
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Sergi Trias-Llimós
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Amand Blanes Llorens
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Iñaki Permanyer
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
- ICREA, 08010 Barcelona, Spain
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Blázquez-Fernández C, Cantarero-Prieto D. The associations between suicides, economic conditions and social isolation: Insights from Spain. PLoS One 2023; 18:e0288234. [PMID: 37418483 DOI: 10.1371/journal.pone.0288234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/21/2023] [Indexed: 07/09/2023] Open
Abstract
Suicide is among the main challenges that need to be addressed in developed countries. In this paper, we analyse suicides across the 17 Spanish regions over the period 2014-2019. More precisely, our objective is to re-study the determinants of suicides focusing on the latest economic expansion period. We use count panel data models and sex stratification. A range of aggregate socioeconomic regional-level factors have been identified. Our empirical results show that: (1) a socioeconomic urban-rural suicide gaps exist; (2) there are significant gender differences, for the women a Mediterranean suicide pattern appears whereas unemployment levels have a significant importance for men, (3) social isolation factors, when significant, they show an (a priori) surprisingly positive result. We provide new highlights for suicide prevention in Spain. Precisely, it is highlighted that jointly policies by gender and attending to vulnerable groups are both necessary.
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Affiliation(s)
- Carla Blázquez-Fernández
- Department of Economics, Universidad de Cantabria, Santander, Spain
- Health Economics Research Group-Valdecilla Health Research Institute (IDIVAL), Santander, Spain
| | - David Cantarero-Prieto
- Department of Economics, Universidad de Cantabria, Santander, Spain
- Health Economics Research Group-Valdecilla Health Research Institute (IDIVAL), Santander, Spain
- Santander Financial Institute-SANFI, Santander, Spain
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3
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Romero I, Díez J, Del Cura I, Franco M, Gullón P. Diet Quality Changes by Educational Level among Adults in Spain from 2017 to 2021. Nutrients 2023; 15:nu15040858. [PMID: 36839216 PMCID: PMC9961002 DOI: 10.3390/nu15040858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Despite increasing attention on addressing socioeconomic disparities in diet quality, longitudinal studies are scarce. Furthermore, the effects of the COVID-19 pandemic on diet-related outcomes are yet to be fully understood. We examined changes in diet quality by educational level among adults in Madrid, Spain. We used data from recruitment (in 2017) and from 2021. At baseline, our sample included 1358 adults aged 40-75 years who were free of cardiovascular disease and completed a validated diet quality screener. Of them, 931 answered the survey in the follow-up visit in 2021. We used participants' diet quality index scores (range: 18-54; higher scores indicate better diet quality) as the dependent variable. As our independent variable, we assessed participants' educational levels (low, medium, and high). We fitted a multinomial regression using the categories of educational level as the main predictor, adjusting for age, sex, country of origin, and household composition. During the study period, 78.0% of participants sustained their diet quality, 11.6% improved it, and 10.4% moved away from a healthier dietary pattern. In descriptive analyses, we observed an increase in diet quality among less-educated females. Unadjusted multinomial models showed that a lower educational level predicted both increases and decreases in diet quality over the period. Even though the median diet quality scores did not change significantly, we observed heterogeneous changes over the four years. Variability within diet, with some improving and some worsening, seems to have increased among participants with lower educational levels. Future studies should look at the determinants of change in these population subgroups.
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Affiliation(s)
- Isabel Romero
- Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Aragón, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain
- Correspondence:
| | - Isabel Del Cura
- Primary Care Research Unit, Madrid Health Service, 28035 Madrid, Spain
- Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos, 28933 Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC) & Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Institute of Health Carlos III, 28029 Madrid, Spain
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, 17165 Stockholm, Sweden
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Pedro Gullón
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain
- Center for Urban Research, RMIT University, Melbourne 3004, Australia
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Fountoulakis KN, Fountoulakis NK, Theodorakis PN, Souliotis K. Overall mortality trends in Greece during the first period of austerity and the economic crisis (2009-2015). Hippokratia 2022; 26:98-104. [PMID: 37324039 PMCID: PMC10266329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The economic crisis and the resulting austerity in Greece led to a drastic reduction in healthcare spending, which has been assumed to have impacted people's health. This paper discusses official standardized mortality rates in Greece between 2000 and 2015. METHODS This study was designed to analyze population-level data and collected data from the World Bank, the Organisation for Economic Co-operation and Development, Eurostat, and the Hellenic Statistics Authority. Separate linear regression models were developed for the periods before and after the crisis and were compared. RESULTS Standardized mortality rates do not support a previously reported assumption of a specific and direct negative effect of austerity on global mortality. Standardized rates continued to decrease linearly, and their correlation to economic variables changed after 2009. Total infant mortality rates show an overall rising trend since 2009, but the interpretation is unclear because of the reduction in the absolute number of deliveries. CONCLUSIONS The mortality data from the first six years of the financial crisis in Greece and the decade that preceded do not support the assumption that budget cuts in health are related to the dramatic worsening of the overall health of the Greek people. Still, data suggest an increase in specific causes of death and the burden on a dysfunctional and unprepared health system that is working in an overstretched manner trying to meet needs. The dramatic acceleration of the aging of the population constitutes a specific challenge for the health system. HIPPOKRATIA 2022, 26 (3):98-104.
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Affiliation(s)
- K N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece
| | | | | | - K Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Greece
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Yu-An Chen A, Sturm R. Depressive Symptoms among US Adults during the Great Recession and Economic Recovery. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2022; 25:3-10. [PMID: 35302049 PMCID: PMC8944938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIMS We study the trajectory of depressive symptoms among US adults before, during, and after the 2008/2009 Great Recession. METHODS We use repeated cross-sectional surveys of the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. Mental health is assessed with the Patient Health Questionnaire-9 (PHQ-9), with the following categorization for depressive symptoms: none or mild (score 0-9), moderate or severe (score 10-27). A parallel time series was calculated from the Behavioral Risk Factor Surveillance System (BRFSS) on self-reported number of days with poor mental health. RESULTS NHANES data show a statistically significant increase in depressive symptoms from 2005/2006 to 2007/2008 (the beginning of the Great Recession), but there were no significant or consistent changes after 2007/2008. In particular, the deterioration in the adjusted predicted PHQ-9 scores occurred prior to the large increase in unemployment rate (2009/2010). As the macroeconomic situations improved and unemployment rates recovered, mental health did not return to the previous level. In the latest wave of NHANES (2017/2018), unemployment rates were at the lowest level over the analysis period; however, the adjusted predicted PHQ-9 scores were higher than that at the beginning of the Great Recession. Trends of PHQ-9 scores were similar across income groups - all groups had an increase in depressive symptoms after 2005/2006 and PHQ-9 scores were still high in 2017/2018 after controlling for sociodemographic status. Group with the lowest income had higher levels of depressive symptoms at every time point. BRFSS data shows no consistent changes in the number of days with poor mental health that parallel economic conditions. DISCUSSION Depressive symptoms at the population level did not match the economic cycle before, during and after the Great Recession. Future research is needed to better understand the lack of correlation between population mental health and macroeconomic conditions.
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Affiliation(s)
- Annie Yu-An Chen
- RAND Corporation, PO Box 2138, 1776 Main Street, Santa Monica, CA 90407-2138, USA,
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Chen AYA, Sturm R. Diet quality in the US improved during the Great Recession and deteriorated during economic recovery. J Acad Nutr Diet 2021; 122:974-980. [PMID: 34954082 PMCID: PMC9038615 DOI: 10.1016/j.jand.2021.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/21/2021] [Accepted: 09/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Macroeconomic changes are associated with population health outcomes, such as mortality, accidents, and alcohol use. Diet quality is a risk or protective factor that could be influenced by economic conditions. OBJECTIVE This study examined the trajectory of diet quality measured by the Healthy ] before, during, and after the 2008/2009 Great Recession. DESIGN Repeated cross-sectional survey data from the National Health and Nutrition Examination Survey (NHANES) were analyzed. PARTICIPANTS/SETTING The analytic sample included 48,679 adults who completed at least one dietary recall from NHANES 1999-2018. MAIN OUTCOME MEASURES Diet quality was assessed with a 24-hour dietary recall to calculate the Healthy Eating Index (HEI)-2015 total scores, a measure of the conformance with the 2015-2020 Dietary Guidelines for Americans. STATISTICAL ANALYSES PERFORMED Least squares regression was used to adjust for demographic changes across waves. RESULTS Diet quality improved noticeably during the Great Recession and deteriorated as economic conditions improved. CONCLUSIONS Deteriorating economic circumstances may constrain choices, but that does not necessarily imply a worsening of dietary quality. During the Great Recession, American diets became more consistent with Dietary Guidelines for Americans recommendations, possibly because of a shift towards food prepared at home instead of prepared food bought away from home.
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Affiliation(s)
- Annie Yu-An Chen
- RAND Corporation, Santa Monica, CA; Pardee RAND Graduate School, Santa Monica, CA.
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Pulido J, Hoyos J, Martínez-Ruiz V, Sordo L, Fernández-Navarro P, Barrio G, Regidor E. Long-term impact of the 2008 economic crisis in Spain on road traffic collisions mortality by socioeconomic position. Health Place 2021; 71:102666. [PMID: 34507036 DOI: 10.1016/j.healthplace.2021.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/24/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
We aimed to assess the effect of the 2008 crisis on road traffic collision (RTC) mortality in Spain, by socioeconomic position (SEP) and type of road use. This prospective, country-wide study covered all adults living in Spain and aged ≥30 years in November 2001. The long-term effect of the crisis was assessed by measuring the monthly percentage change (MPC) in RTC mortality between the pre-crisis (2002-2007) and crisis period (2008-2011). During the recession, RTC mortality fell more in people with low compared to high SEP, so MPCs difference between periods were of a higher magnitude in the low compared to high SEP groups, especially among men motorcyclists. RTC mortality trends were favorable following the 2008 crisis, particularly among low-SEP groups. In men motorcyclists, the upward trend of the pre-crisis period reversed course.
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Affiliation(s)
- J Pulido
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid. Plaza Ramón y Cajal, S/n., 28040, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain
| | - J Hoyos
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain.
| | - V Martínez-Ruiz
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Avda. de La Investigación 11. 18016, Granada, Spain
| | - L Sordo
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid. Plaza Ramón y Cajal, S/n., 28040, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain
| | - P Fernández-Navarro
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Calle Sinesio Delgado, 4. 28029, Madrid, Spain
| | - G Barrio
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; National School of Public Health. Carlos III Institute of Health, Calle Sinesio Delgado, 4. 28029, Madrid, Spain
| | - E Regidor
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid. Plaza Ramón y Cajal, S/n., 28040, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Calle Del Profesor Martín Lagos. 28040, Madrid, Spain
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García-Mayor J, Moreno-Llamas A, De la Cruz-Sánchez E. Inequalities in the long-term impact of the economic recession on preventive healthcare use and health-related lifestyle in Spain (2006-2017). HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:42-55. [PMID: 32557930 DOI: 10.1111/hsc.13067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
Study of the long-term impact of economic recession on lifestyle according to socioeconomic groups is scarce. This study examines health-related lifestyle and preventive medical attendance in different socioeconomic groups in the Spanish adult population (18-64 years of age) before, during and after an economic recession. Data were collected from three waves of the Spanish National Health Survey (2006, 2012 and 2017). Self-perceived health, health-related lifestyle and common preventive medical attendance were evaluated by means of multivariate logistic models. The increase in good self-perceived health in 2006-2012 was 7.1%, 6.9% and 8.3% for the high, middle and low group, respectively, and 5.2%, 5.9% and 7.9% for the high, middle and low group, respectively, in 2006-2017. In 2006-2012 and 2006-2017, the gap increased between people of the high and low groups in smoking prevalence (2.8%-4.7%), physical activity (2.0%-4.0%), daily fruit (1.0%-6.3%) and vegetable intake (2.5%-6.1%). The probability of women´s gynaecological attendance increased statistically significant for cytology in three groups in 2006-2012 and 2006-2017 (OR = 1.35, 95% CI = 1.08-1.67; OR = 1.42, 95% CI = 1.18-1.7; OR = 1.34, 95% CI = 1.21-1.47 for the high, middle and low groups, respectively, in 2006-2012 and OR = 1.34, 95% CI = 1.08-1.67; OR = 1.62, 95% CI = 1.35-1.95; OR = 1.51, 95% CI = 1.37-1.66 for the high, middle and low groups, respectively, in 2006-2017), but not for mammography. This study reveals long-term socioeconomic inequalities in lifestyle behaviours after the economic recession. Health policies must be emphasised in these population subgroups and in more disadvantaged populations.
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Borra C, Pons-Pons J, Vilar-Rodríguez M. Austerity, healthcare provision, and health outcomes in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:409-423. [PMID: 31853673 DOI: 10.1007/s10198-019-01141-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
The recession that started in the United States in December 2007 has had a significant impact on the Spanish economy through a large increase in the unemployment rate and a long recession which led to tough austerity measures imposed on public finances. Taking advantage of this quasi-natural experiment, we use data from the Spanish Ministry of Health from 1996 to 2015 to provide novel causal evidence on the short-term impact of changes in healthcare provision and regulations on health outcomes. The fact that regional governments have discretionary powers in deciding healthcare budgets and that austerity measures have not been implemented uniformly across Spain helps isolate the impact of these policy changes on health indicators of the Spanish population. Using Ruhm's (Q J Econ 115(2):617-650, 2000) fixed effects model, we find that medical staff and hospital bed reductions account for a significant increase in mortality rates from circulatory diseases and external causes, but not from other causes of death. Similarly, mortality rates do not seem to be robustly affected by the 2012 changes in retirees' pharmaceutical co-payments and access restrictions for illegal immigrants. Our results are robust to changes in model specification and sample selection and are primarily driven by accidental and emergency deaths rather than in-hospital mortality, which suggests a larger role for decreases in accessibility rather than decreases in healthcare quality as impact channels.
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