Stable socioeconomic inequalities in ischaemic heart disease mortality during the economic crisis: a time trend analysis in 2 Spanish settings

Xavier Bartoll,Laia Palència,Mercè Gotsens,Carme Borrell,Santiago Esnaola,Montse Calvo,Marc Marí-Dell’Olmo

doi:10.1186/s13690-019-0339-z

Abstract

BackgroundPrior studies have identified a decrease in ischaemic heart disease mortality during the recent economic recession. The Spanish population was severely affected by the Great Recession, however, there is little evidence on its effects on socioeconomic inequalities in ischaemic heart disease mortality. This study examines trends in socioeconomic inequalities in mortality due to ischaemic heart disease (IHD).MethodsWe used linked census records with mortality registers available from the Basque Country and Barcelona city for population above 25 years, between 2001 and 04, the accelerated economic growth period of 2005–08, and 2009–12, with the last period coinciding with the Great Recession. Applying Poisson models, we calculated relative and absolute indexes of inequalities by education level for each period, age group, gender, and site.ResultsWe found moderate age-adjusted inequalities in IHD with a gradient of increasing rates through less educational level, but no significant evidence of increasing trends in socioeconomic inequalities in IHD mortality, rather an inverted U-shape time trend in some groups below 75 years in relative inequalities. Absolute inequalities decrease in the last period except for women from 50 to 64 years.ConclusionsThis study shows that the economic crisis has not increased socioeconomic inequalities in IHD mortality in two geographical settings in Spain.

Highlights

Prior studies have identified a decrease in ischaemic heart disease mortality during the recent economic recession
The objective of this paper is to analyse trends in socioeconomic inequalities of ischaemic heart disease (IHD) mortality before and during the Great Recession (2009–12) according to education level
For men in Basque Country, IHD deaths rates decrease for most groups, except for those in university from 50 to 64 years and lower secondary above 75 years

Summary

Introduction

Prior studies have identified a decrease in ischaemic heart disease mortality during the recent economic recession. The Spanish population was severely affected by the Great Recession, there is little evidence on its effects on socioeconomic inequalities in ischaemic heart disease mortality. An influential study in the late 70’s found that economic recessions were related to increased cardiovascular mortality [1]. This result was soon challenged [2] by new evidence based on more sound panel methodology showing just the opposite, that the increased unemployment was associated with a decline in cardiovascular mortality [3]. The economic recession has severely affected the Spanish population, with a rapid rise in unemployment, work precariousness and vulnerable population increasing socioeconomic inequalities [12]. As in the European context, the austerity measures imposed in Spain may have negatively affected health and health services [13, 14]

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