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I Vlachos Ι, Ktena Y, Athanasiadou A, Charmandari E, Moschovi M. Psychosocial adaptation of families with children newly diagnosed with cancer in the Greek population amidst the socioeconomic crisis. J Psychosoc Oncol 2023; 41:673-686. [PMID: 36621825 DOI: 10.1080/07347332.2022.2160943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To present the initial assessment of psychosocial adaptation among Greek parents whose children were newly diagnosed with cancer amidst the turmoil of an ongoing financial crisis. STUDY DESIGN This prospective observational study used a quantitative approach. PARTICIPANTS Sixty-one parents of children with cancer treated at a large urban tertiary-care children's hospital were prospectively recruited to participate in our study during the first week of their child's diagnosis (2013-2016). METHODS The parents were asked to complete the psychosocial assessment tool (PAT 2.0), Zung Depression Scale, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, and World Health Organization Quality of Life-Bref Instrument; Moreover, three female healthcare providers (the physician oncologist, the head nurse and a senior nurse) completed the relevant PAT 2.0 -Staff Perceptions questionnaire the results of which were then compared to those of the child's parent. FINDINGS The majority of parents had PAT 2.0 scores indicative of increased psychosocial risk :54% were stratified into the "Targeted" (moderate risk) and 15% into the "Clinical" (highest risk) categories, whereas healthcare providers underestimated psychosocial risk in 57%-59% of the cases. The subscales that most contributed to the increased scores were Parental Stress Reaction, Family Structure and Resources, and Family Social Support. The PAT 2.0 had statistically significant correlations with most of the anxiety and depression scales, with Zung having the strongest correlation (r-value: +0.5, p-value <0.01). Our cohort presented more anxiety and depression compared to the general Greek population (14% for depression versus 2,9% for the general population and 46% for anxiety compared to 4,1%) in the years of financial recession in Greece. CONCLUSIONS The parents of children newly diagnosed with cancer in Greece are at increased risk for developing anxiety and depression in the years of financial recession in Greece compared to general population. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Parental stress reaction to diagnosis as well as lack of family resources and social support may contribute to this difference. Screening for psychosocial risk factors is essential for the early identification of these families and for the optimal utilization of the limited available resources in times of economic hardship.
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Affiliation(s)
- Ιlias I Vlachos
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sοphia" Children's Hospital, Athens, Greece
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Yiouli Ktena
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sοphia" Children's Hospital, Athens, Greece
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Anastasia Athanasiadou
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sοphia" Children's Hospital, Athens, Greece
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sοphia" Children's Hospital, Athens, Greece
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Palència L, Ferrando J, Marí-Dell'Olmo M, Gotsens M, Morrison J, Dzurova D, Lustigova M, Costa C, Rodríguez-Sanz M, Bosakova L, Santana P, Borrell C. Socio-economic inequalities on cancer mortality in nine European areas: The effect of the last economic recession. Cancer Epidemiol 2020; 69:101827. [PMID: 33038640 DOI: 10.1016/j.canep.2020.101827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The effect of inequalities aggravated by economic recessions in the mortality rates of certain diseases has been previously described. In this study, we analyzed the relationship between socio-economic deprivation and cancer mortality. We focused on lung, colon, prostate, and breast cancers in nine European urban areas over three periods: two before (2000-2003 and 2004-2008) and one after (2009-2014) the onset of the 2008 financial crisis. METHODS This is an ecological study of trends. The units of analysis were small areas within nine European urban areas. We used a composite deprivation index as a socio-economic indicator. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyze the evolution of socio-economic inequalities, we fitted an ecological regression model that included the socio-economic indicator, the period of time, and the interaction between these terms. RESULTS In men, socio-economic inequalities in all-cancer and lung cancer mortality were observed in most of the cities studied, but did not increase after the onset of the economic crisis. In women, only two cities (Stockholm and London) showed socio-economic inequalities in all-cancer and lung cancer mortality; there was also no increase in inequalities. CONCLUSIONS Our results did not validate our hypothesis that inequalities increase in times of crisis. However, they emphasize the importance of socio-economic measurements for understanding mortality inequalities, and can be used to inform prevention strategies and help plan local health programs aimed at reducing health inequalities.
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Affiliation(s)
- Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | | | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Joana Morrison
- Institute of Health Equity at the Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Lucia Bosakova
- Department of Health Psychology and Research Methodology, Medical Faculty, P. J. Safarik University in Kosice, Kosice, Slovak Republic; Olomouc University Social Health Institute (OUSHI), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
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Thompson K, Ophem JV, Wagemakers A. Studying the impact of the Eurozone's Great Recession on health: Methodological choices and challenges. ECONOMICS AND HUMAN BIOLOGY 2019; 35:162-184. [PMID: 31376735 DOI: 10.1016/j.ehb.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
Europe's Great Recession provides an opportunity to study the impact of increased financial insecurity on health. A number of studies explored the impact of the Recession on health, but they often reached different conclusions. To understand the root of this debate, we undertook a systematic literature review. Articles were analysed thematically based on: geography, data type, operationalisations of wealth and health, and study design. A critical appraisal was also undertaken. Forty-two studies, published from January 2010 to October 2018, were included in our review. Twenty-six of the forty-two studies found that the Great Recession worsened physical health indicators in the Eurozone. In terms of geography, a large concentration of studies focussed on Spain and Greece, indicating that there may be a gap in understanding the health consequences for EU countries with less severe experiences of the Recession. Regarding data type, nearly all studies used secondary datasets, possibly meaning that studies were constrained by the data available. In terms of operationalisations of wealth and health, a majority of studies used single/simple measures of both, so that these multi-faceted concepts were not fully reflected. Further, fewer than half included studies used panel data, with the remaining studies unable to undertake more causal analyses. The results of the critical appraisal showed that lower-quality studies tended to not find a negative impact of the Recession on health, whereas higher quality studies generally did. In future, we recommend conducting cross-country comparisons, using (inter)nationally-representative panel data conducted over a minimum of a ten-year time horizon, and employing multi-faceted operationalisations of wealth and health. This could provide more common ground across studies, and a clearer indication of whether the Recession impacted health.
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Affiliation(s)
- Kristina Thompson
- Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands.
| | - Johan van Ophem
- Chair Group Urban Economics, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
| | - Annemarie Wagemakers
- Chair Group Health and Society, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
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Vardakas KZ, Kyriakidou M, Apiranthiti KN, Almpani SE, Heliou D, Stratigopoulou D, Giourmetaki E, Lamprou D, Binou G, Mpaltzoglou E, Falagas ME. Trends of Mortality in Greece Prior to and During Its Current Financial Crisis (2009-2015). Rambam Maimonides Med J 2019; 10:RMMJ.10368. [PMID: 31335309 PMCID: PMC6649780 DOI: 10.5041/rmmj.10368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To study mortality changes in Greece prior to and during the financial crisis. STUDY DESIGN Analysis of data by the Hellenic Statistical Authority (1955-2015). RESULTS During the crisis, mortality increased from 9.76/1000 in 2009 to 10.52/1000 in 2012 and to 11.16/1000 in 2015, driven by an increase in the number of deaths and a decrease in the estimated population. The annual increase of the expected mortality accelerated during the crisis; in contrast, age-adjusted mortality continued to decrease up to 2014 and increased in 2015. The subpopulations that seemed to be affected more during the crisis were the elderly (especially those over 70 years), women, and citizens in southern Greece. The common denominator of all these subgroups was older age. Mortality due to heart diseases continued to decline at an accelerated pace; due to neoplasia continued to increase at an accelerated pace; and stroke mortality reversed (from decline to increment). CONCLUSIONS The increment of crude mortality during the financial crisis in Greece should be attributed to the increase in deaths, only in part due to the aging population, the reduction in births, and the increase in emigration that contracted the population.
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Affiliation(s)
- Konstantinos Z Vardakas
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Internal Medicine, Henry Dunant Hospital Center, Athens, Greece
| | - Margarita Kyriakidou
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | | | - Spiridoula E Almpani
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Dominiki Heliou
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Dimitra Stratigopoulou
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Eleni Giourmetaki
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Dimitra Lamprou
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Georgia Binou
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Elena Mpaltzoglou
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Matthew E Falagas
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Internal Medicine, Henry Dunant Hospital Center, Athens, Greece
- Department of Internal Medicine, Tufts University School of Medicine, Boston, MA, USA
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Ferrando J, Palència L, Gotsens M, Puig-Barrachina V, Marí-Dell'Olmo M, Rodríguez-Sanz M, Bartoll X, Borrell C. Trends in cancer mortality in Spain: the influence of the financial crisis. GACETA SANITARIA 2018; 33:229-234. [PMID: 29452751 DOI: 10.1016/j.gaceta.2017.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine if the onset of the economic crisis in Spain affected cancer mortality and mortality trends. METHOD We conducted a longitudinal ecological study based on all cancer-related deaths and on specific types of cancer (lung, colon, breast and prostate) in Spain between 2000 and 2013. We computed age-standardised mortality rates in men and women, and fit mixed Poisson models to analyse the effect of the crisis on cancer mortality and trends therein. RESULTS After the onset of the economic crisis, cancer mortality continued to decline, but with a significant slowing of the yearly rate of decline (men: RR = 0.987, 95%CI = 0.985-0.990, before the crisis, and RR = 0.993, 95%CI = 0.991-0.996, afterwards; women: RR = 0.990, 95%CI = 0.988-0.993, before, and RR = 1.002, 95%CI = 0.998-1.006, afterwards). In men, lung cancer mortality was reduced, continuing the trend observed in the pre-crisis period; the trend in colon cancer mortality did not change significantly and continued to increase; and the yearly decline in prostate cancer mortality slowed significantly. In women, lung cancer mortality continued to increase each year, as before the crisis; colon cancer continued to decease; and the previous yearly downward trend in breast cancer mortality slowed down following the onset of the crisis. CONCLUSIONS Since the onset of the economic crisis in Spain the rate of decline in cancer mortality has slowed significantly, and this situation could be exacerbated by the current austerity measures in healthcare.
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Affiliation(s)
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain.
| | | | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
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Gomez SL, Canchola AJ, Nelson DO, Keegan THM, Clarke CA, Cheng I, Shariff-Marco S, DeRouen M, Catalano R, Satariano WA, Davidson-Allen K, Glaser SL. Recent declines in cancer incidence: related to the Great Recession? Cancer Causes Control 2017; 28:145-154. [PMID: 28130633 DOI: 10.1007/s10552-016-0846-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 12/22/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE In recent years, cancer case counts in the U.S. underwent a large, rapid decline-an unexpected change given population growth for older persons at highest cancer risk. As these declines coincided with the Great Recession, we examined whether they were related to economic conditions. METHODS Using California Cancer Registry data from California's 30 most populous counties, we analyzed trends in cancer incidence during pre-recession (1996-2007) and recession/recovery (2008-2012) periods for all cancers combined and the ten most common sites. We evaluated the recession's association with rates using a multifactorial index that measured recession impact, and modeled associations between case counts and county-level unemployment rates using Poisson regression. RESULTS Yearly cancer incidence rate declines were greater during the recession/recovery (3.3% among males, 1.4% among females) than before (0.7 and 0.5%, respectively), particularly for prostate, lung, and colorectal cancers. Lower case counts, especially for prostate and liver cancer among males and breast cancer, melanoma, and ovarian cancer among females, were associated with higher unemployment rates, irrespective of time period, but independent of secular effects. The associations for melanoma translated up to a 3.6% decrease in cases with each 1% increase in unemployment. Incidence declines were not greater in counties with higher recession impact index. CONCLUSIONS Although recent declines in incidence of certain cancers are not differentially impacted by economic conditions related to the Great Recession relative to pre-recession conditions, the large recent absolute declines in the case counts of some cancer may be attributable to the large declines in unemployment in the recessionary period. This may occur through decreased engagement in preventive health behaviors, particularly for clinically less urgent cancers. Continued monitoring of trends is important to detect any rises in incidence rates as deferred diagnoses come to clinical attention.
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Affiliation(s)
- Scarlett Lin Gomez
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA. .,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA. .,Stanford Cancer Institute, Stanford, USA.
| | - Alison J Canchola
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA
| | - David O Nelson
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, USA
| | - Theresa H M Keegan
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Christina A Clarke
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, USA
| | - Iona Cheng
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Stanford Cancer Institute, Stanford, USA
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, USA
| | - Mindy DeRouen
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Kathleen Davidson-Allen
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA
| | - Sally L Glaser
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, USA
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