Abstract
Although winter mortality and morbidity are phenomena common to most European countries, their magnitude varies significantly from country to country. The geographical disparities among regions with similar climates are the result of several social, economic, demographic, and biological conditions that influence an individual's vulnerability to winter conditions. The impact of poor socioeconomic conditions may be of such magnitude that an economic recession may aggravate the seasonal mortality pattern. This paper aims to measure the seasonal winter mortality, morbidity, and their related costs during the Great Recession (2009-2012) in mainland Portugal and its Regional Health Administrations (RHAs) and to compare it with the periods preceding and following it. Monthly mortality and morbidity data were collected and clustered into three periods: Great Recession (2009-2012), Pre-Recession (2005-2008), and Post-Recession (2013-2016). The impact of seasonal winter mortality and morbidity during the Great Recession in Portugal and its Regional Health Administrations was measured through the assessment of age-standardized excess winter (EW) death and hospital admissions rate and index, expected life expectancy gains without EW deaths, EW rate of potential years of life lost, and EW rate of emergency hospital admission costs. Important increases of winter deaths and hospital admissions were identified, resulting in an important number of potential years of life lost (87years of life lost per 100,000 inhabitants in 2009-2012), life expectancy loss (1year in 2009-2012), and National Health Service costs with explicit temporal and spatial variations. These human and economic costs have decreased consistently during the analyzed periods, while no significant increase was found during the Great Recession. Despite its reduction, the winter excess morbidity and mortality highlight that Portugal still faces substantial challenges related to a highly vulnerable population, calling for investments in better social and health protection.
Highlights
The monthly distribution of mortality throughout the year— i.e., the so-called seasonal behavior—is well-known, and is generally characterized by a winter peak, often referred to as excess winter (EW) mortality (Dimitriou et al 2016)
In Portugal, winter deaths during the Great Recession were almost 30% higher than the number for non-winter mortality; this value was significantly lower than that of the previous period and significantly higher than that of the following (EW death index in 2005–2008, 31.6%; 2009–2012, 29.0%; 2013–2016, 28.1%) (Fig. 3a)
This decreasing trend was common to all regions, except for Alentejo, where the EW mortality index increased in both the 2005–2008 and 2009–2012 periods
Summary
The monthly distribution of mortality throughout the year— i.e., the so-called seasonal behavior—is well-known, and is generally characterized by a winter peak, often referred to as excess winter (EW) mortality (Dimitriou et al 2016). A relationship between socioeconomic conditions and excess winter mortality is often found (Healy 2003). Most of EW mortality is related to diseases of the circulatory and respiratory system (Rau 2004; Antunes et al 2017). Exposure to low temperatures can have severe biological consequences, producing changes in blood pressure, causing vasoconstriction, and increasing the levels of plasma fibrinogen and cholesterol (Mercer 2003; Sartini et al 2016), while the inhalation of cold air is related to higher risk of bronchitis, pneumonia, and acute exacerbation of chronic lung diseases (Ou et al 2013). The consequences of the exposure to harmful weather conditions are greater in older people (Rudge and Gilchrist 2005; Benmarhnia et al 2014) where the overlapping of biological and social fragility is frequent
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