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

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          Abstract

          Background

          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, 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).

          Methods

          We 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.

          Results

          We 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.

          Conclusions

          This study shows that the economic crisis has not increased socioeconomic inequalities in IHD mortality in two geographical settings in Spain.

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          Most cited references19

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          Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: a systematic review.

          Due to the current economic crisis in Greece, effects on health and healthcare have been reported. The aim of this study was to present a systematic overview of the consequences that the financial crisis has had for health and healthcare in Greece.
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            Recessions, healthy no more?

            Over the 1976-2010 period, total mortality shifted from strongly procyclical to being weakly or unrelated to macroeconomic conditions. The association is likely to be poorly measured when using short (less than 15 year) analysis periods. Deaths from cardiovascular disease and transport accidents continue to be procyclical; however, countercyclical patterns have emerged for fatalities from cancer mortality and external causes. Among the latter, non-transport accidents, particularly accidental poisonings, play an important role.
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              A healthy economy can break your heart.

              Panel data methods are used to investigate how deaths from coronary heart disease (CHD) in the United States vary with macroeconomic conditions. A one-percentage-point reduction in unemployment is predicted to raise CHD mortality by 0.75%, corresponding to almost 3900 additional fatalities. The increase in relative risk is similar across age groups, implying that senior citizens account for most of the extra deaths. Direct evidence is obtained of a role for decreases in medical interventions treating coronary problems. CHD mortality increases rapidly when the economy strengthens but returns to or near its baseline level within five years for most groups.
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                Author and article information

                Contributors
                34 93 238 45 45 , xbartoll@aspb.cat
                mgotsens@aspb.cat
                mmari@aspb.cat
                lpalenci@aspb.cat
                mcalvo@ej-gv.es
                sesnaola@gmail.com
                cborrell@aspb.cat
                Journal
                Arch Public Health
                Arch Public Health
                Archives of Public Health
                BioMed Central (London )
                0778-7367
                2049-3258
                15 March 2019
                15 March 2019
                2019
                : 77
                : 12
                Affiliations
                [1 ]ISNI 0000 0001 2164 7602, GRID grid.415373.7, Agència de Salut Pública de Barcelona, ; Plaça Lesseps 1, 08023 Barcelona, Spain
                [2 ]ISNI 0000 0000 9314 1427, GRID grid.413448.e, CIBER Epidemiología y Salud Pública (CIBERESP), ; Madrid, Spain
                [3 ]Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
                [4 ]ISNI 0000 0001 2172 2676, GRID grid.5612.0, Universitat Pompeu Fabra, ; Barcelona, Spain
                [5 ]Departamento de Salud, Gobierno del País Vasco, Bilbao, Spain
                Article
                339
                10.1186/s13690-019-0339-z
                6419419
                30918659
                95a4a7a6-639f-4c41-841f-a328e7ce4f1e
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 November 2018
                : 20 February 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004587, Instituto de Salud Carlos III;
                Award ID: PI13/00897
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Public health
                ischaemic heart disease mortality,socioeconomic inequalities,economic,crisis,spain
                Public health
                ischaemic heart disease mortality, socioeconomic inequalities, economic, crisis, spain

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