Abstract
Greece was one of the countries hit the hardest by the 2008 financial crisis in Europe. Yet, evidence on the effect of the crisis on total and cause-specific mortality remains unclear. We explored whether the economic crisis affected the trend of overall and cause-specific mortality rates. We used regional panel data from the Hellenic Statistical Authority to assess mortality trends by age, sex, region, and cause in Greece between January, 2001, and December, 2013. We used Eurostat data to calculate monthly age-standardised mortality rates per 100 000 inhabitants for each region. Data were divided into two subperiods: before the crisis (January, 2001, to August, 2008) and after the onset of the crisis (September, 2008, to December, 2013). We tested for changes in the slope of mortality by doing an interrupted time-series analysis. Overall mortality continued to decline after the onset of the financial crisis (-0·065, 95% CI -0·080 to -0·049), but at a slower pace than before the crisis (-0·13, -0·15 to -0·10; trend difference 0·062, 95% CI 0·041 to 0·083; p<0·0001). The trend difference was more evident for females (0·087, 95% CI 0·064-0·11; p<0·0001) than for males (0·040, 0·013-0·066; p=0·007). Those aged at least 75 years experienced more negative effects (trend difference 0·056, 95% CI 0·042 to 0·071; p<0·0001) than did those aged 20-34 years, in whom mortality trends improved (-0·0074, -0·0089 to -0·0059; p<0·0001). Deaths by diseases of the circulatory system declined more slowly after the onset of compared with before the crisis (trend difference 0·043, 95% CI 0·024 to 0·063; p<0·0001), whereas deaths from vehicular accidents declined faster (-0·0062, -0·0090 to -0·0033; p<0·0001), most prominently among men aged 20-34 years (-0·0065, -0·0085 to -0·0044; p<0·0001). Conversely, deaths from suicides (trend difference 0·0021, 95% CI 0·00092-0·0033; p=0·002), diseases of the nervous system (0·0036, 0·0016-0·0056; p=0·002), and mental health problems (0·00073, 0·000047-0·0014 p=0·038) increased after the onset of the crisis. Also, deaths due to adverse events during medical treatment increased significantly after the onset of the crisis (trend difference 0·0020, 95% CI 0·0012-0·0028; p<0·0001). By comparing the expected values of the period after the onset of the crisis with extrapolated values based on the period before the crisis, we estimate that an extra 242 deaths per month occurred after the onset of the crisis. Mortality trends have been interrupted after the onset of compared with before the crisis, but changes vary by age, sex, and cause of death. The increase in deaths due to adverse events during medical treatment might reflect the effects of deterioration in quality of care during economic recessions. None.
Highlights
Following the 2008 global financial crisis, Greece has been experiencing one of the most severe financial crises in its recent history, with uncontrolled public debt and an exponential increase in unemployment
Our study focuses on overall mortality and on the main causes of death in Greece, including deaths from circulatory diseases, cancer, respiratory conditions, nervous system diseases and digestive diseases, as well as the main causes discussed in the literature on economic crises, including deaths from vehicular accidents, suicides, homicides, infectious diseases and conditions related to pregnancy and childbirth.[6,9] We focus on causes that we hypothesize may be linked to the deterioration of health care during recession, such as deaths due to adverse events during medical treatment
Regarding the cause-specific mortality rates examined in Figure 1, we observe that deaths from cardiovascular diseases continue to fall and to a lesser extent, while deaths due to vehicular accidents, cancer, respiratory diseases, pregnancy-related conditions and infectious diseases have declined faster during the crisis
Summary
Following the 2008 global financial crisis, Greece has been experiencing one of the most severe financial crises in its recent history, with uncontrolled public debt and an exponential increase in unemployment. Reductions in household budgets, due to unemployment or reduction in pensions and wages, decrease individuals’ ability to pay for health care, again leading potentially to deterioration of health outcomes. This seems more evident in countries with weaker social protection schemes.[6] On the other hand, it has been argued that during economic recessions, increases in tobacco and alcohol taxation may lead individuals to adopt healthier lifestyles, while traffic deaths are pro-cyclical and tend to decrease as unemployment increases due to a drop in the use of cars.[7] And still, how lifestyle behaviours change during recessions is not clear. The paper explores whether the economic crisis has interrupted the level and/or the trend of mortality rates
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