Economic Crisis and Amenable Mortality in Spain.

Area of Science:

• Public Health
• Health Economics
• Epidemiology

Background:

• European countries have seen decreasing mortality rates, yet socioeconomic disparities persist, increasing death risks for less privileged groups.
• The 2008 economic recession's impact on population health is debated, with conflicting evidence on pro-cyclical (positive) versus counter-cyclical (negative) health outcomes.
• Understanding the crisis's health effects is crucial for public health policy.

Purpose of the Study:

• To analyze changes in overall and amenable mortality in Spain from 2002-2007 (pre-crisis) to 2008-2013 (during crisis).
• To examine national and provincial trends in mortality risks and their association with crisis impact indicators.
• To investigate the relationship between socioeconomic vulnerability and mortality changes during the economic downturn.

Main Methods:

• Ecological study design comparing mortality data from two distinct periods: 2002–2007 and 2008–2013.
• Calculation of Age Standardized Rates for overall and amenable mortality, and their percentage change between the periods.
• Analysis of the association between provincial crisis impact indicators and observed mortality changes, including categorization of amenable mortality into five groups.

Main Results:

• Amenable mortality decreased from 8.25% to 6.93% of overall mortality between the periods.
• Both overall and amenable mortality rates declined, with amenable mortality showing a sharper decrease.
• Mortality declines were directly linked to vulnerability indicators, with significant reductions in ischemic heart disease and cerebrovascular disease.

Conclusions:

• Amenable mortality decreased more significantly than overall mortality across Spain between the study periods, though provincial variations exist.
• Higher vulnerability indicators correlated with greater mortality declines, but this relationship varied by cause of death.
• Interpreting mortality trends during economic crises requires caution, acknowledging potential pro-cyclical health effects and socioeconomic influences.