Effect of the Financial Crisis on Socioeconomic Inequalities in Mortality in Small Areas in Seven Spanish Cities.

Mercè Gotsens,Antonio Daponte,Laia Palència,Xavier Bartoll,Pablo Sanchez-Villegas,Ana Gandarillas,Marc Marí-Dell’Olmo,Josep Ferrando,Santi Esnaola,Carme Borrell

doi:10.3390/ijerph17030958

Abstract

Background: The aim of this study was to analyze the trend in socioeconomic inequalities in mortality in small areas due to several specific causes before (2001–2004, 2005–2008) and during (2009–2012) the economic crisis in seven Spanish cities. Methods: This ecological study of trends, with census tracts as the areas of analysis, was based on three periods. Several causes of death were studied. A socioeconomic deprivation index was calculated for each census tract. For each small area, we estimated standardized mortality ratios, and controlled for their variability using Bayesian models (sSMR). We also estimated the relative risk of mortality according to deprivation in the different cities, periods, and sexes. Results: In general, a similar geographical pattern was found for the socioeconomic deprivation index and sSMR. For men, there was an association in all cities between the deprivation index and all-cause mortality that remained stable over the three periods. For women, there was an association in Barcelona, Granada, and Sevilla between the deprivation index and all-cause mortality in the third period. Patterns by causes of death were more heterogeneous. Conclusions: After the start of the financial crisis, socioeconomic inequalities in total mortality in small areas of Spanish cities remained stable in most cities, although several causes of death showed a different pattern.

Highlights

The impact of economic crises on populations’ health depends on various factors, such as the institutional, cultural, and socioeconomic context of the society, the severity and duration of the crisis, and the responses articulated to combat it [1,2,3,4,5,6,7]
The geographical pattern was similar for the socioeconomic deprivation index and Smoothed SMR (sSMR)
For some specific causes of death, previously absent inequalities appeared in the crisis period, especially among men

Summary

Introduction

The impact of economic crises on populations’ health depends on various factors, such as the institutional, cultural, and socioeconomic context of the society, the severity and duration of the crisis, and the responses articulated to combat it [1,2,3,4,5,6,7]. The aim of this study was to analyze the trend in socioeconomic inequalities in mortality in small areas due to several specific causes before (2001–2004, 2005–2008) and during (2009–2012) the economic crisis in seven Spanish cities. A socioeconomic deprivation index was calculated for each census tract. We estimated the relative risk of mortality according to deprivation in the different cities, periods, and sexes. Results: In general, a similar geographical pattern was found for the socioeconomic deprivation index and sSMR. There was an association in all cities between the deprivation index and all-cause mortality that remained stable over the three periods. There was an association in Barcelona, Granada, and Sevilla between the deprivation index and all-cause mortality in the third period.

Objectives

Methods

Results

Discussion

Conclusion