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      Impacto de la crisis económica sobre la percepción de la salud en la población española Translated title: Impact of the financial crisis on health perception in the Spanish population

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          Abstract

          RESUMEN Objetivo: analizar el impacto de la situación económica en la percepción del estado de salud y la capacidad explicativa de las características individuales en esta percepción. Método: estudio transversal con enfoque analítico. Se extrajeron datos de la Encuesta Nacional de Salud (ENSE) publicada en 2011-2012 (crisis económica) y en 2017 (recuperación). La variable dependiente fue la percepción de la salud recogida en una escala Likert de 1 (muy bueno) a 5 (muy malo). Las variables independientes fueron: el momento de recogida (crisis/recuperación), sociodemográficas, relacionadas con el estilo de vida, relativas al estado «objetivo» de salud y relacionadas con el uso de servicios. Se construyeron modelos lineales generalizados para dar respuesta a los objetivos. Para valorar la magnitud del tamaño del efecto de las asociaciones se valoró la dispersión de las distribuciones según la relación existente entre el efecto y la desviación estándar de la media (DS). Resultados: se encontró una mejoría en la percepción del estado de salud de -0,066 (intervalo de confianza [IC] 95%: entre -0,080 y -0,052) puntos en el período de recuperación. Se hallaron asociaciones de tamaño del efecto «moderado» entre una peor percepción de salud y las variables relacionadas con el estado «objetivo» de salud; y «pequeño», con las variables relacionadas con el estilo de vida poco saludable y la clase social más desfavorecida. Conclusión: los períodos de crisis económica se asocian a una peor percepción del estado de salud, impactando más en aquella población perteneciente a una categoría social baja, con hábitos de vida poco saludables y especialmente en los pacientes crónicos.

          Translated abstract

          ABSTRACT Objective: to analyse the impact of the economic situation on the perception of health status and the explanatory role of certain individual characteristics in its variability. Method: cross-sectional study with an analytical approach. Data from the Spanish National Health Survey (NHS) published in 2011/12 (economic crisis) and 2017 (recovery) were used. The dependent variable was self-perceived health measured on a Likert scale from 1 (very good) to 5 (very bad). Independent variables were: the time of collection (crisis/recovery), socio-demographic, lifestyle-related, related to “objective” health status and related to service use. Generalised Linear Models were constructed to tackle the objectives. To evaluate the magnitude of the effect size of the associations, the dispersion of the distributions was assessed according to the ratio of the effect to the standard deviation of the mean (SD). Results: an improvement in the self-perceived health of -0.066 (95%CI: -0.080/-0.052) points was detected for the recovery period. “Moderate” effect size associations were revealed between worse self-perceived health and variables related to “objective” health status and “small” with variables related to unhealthy lifestyle and most deprived social class. Conclusion: periods of the economic crisis are associated with worse self-perceived health with a greater impact on the population belonging to a low social category, unhealthy lifestyle habits and especially on chronic patients.

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          Most cited references28

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          Bayes Factors

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            Likert scales, levels of measurement and the "laws" of statistics.

            Reviewers of research reports frequently criticize the choice of statistical methods. While some of these criticisms are well-founded, frequently the use of various parametric methods such as analysis of variance, regression, correlation are faulted because: (a) the sample size is too small, (b) the data may not be normally distributed, or (c) The data are from Likert scales, which are ordinal, so parametric statistics cannot be used. In this paper, I dissect these arguments, and show that many studies, dating back to the 1930s consistently show that parametric statistics are robust with respect to violations of these assumptions. Hence, challenges like those above are unfounded, and parametric methods can be utilized without concern for "getting the wrong answer".
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              Financial crisis, austerity, and health in Europe.

              The financial crisis in Europe has posed major threats and opportunities to health. We trace the origins of the economic crisis in Europe and the responses of governments, examine the effect on health systems, and review the effects of previous economic downturns on health to predict the likely consequences for the present. We then compare our predictions with available evidence for the effects of the crisis on health. Whereas immediate rises in suicides and falls in road traffic deaths were anticipated, other consequences, such as HIV outbreaks, were not, and are better understood as products of state retrenchment. Greece, Spain, and Portugal adopted strict fiscal austerity; their economies continue to recede and strain on their health-care systems is growing. Suicides and outbreaks of infectious diseases are becoming more common in these countries, and budget cuts have restricted access to health care. By contrast, Iceland rejected austerity through a popular vote, and the financial crisis seems to have had few or no discernible effects on health. Although there are many potentially confounding differences between countries, our analysis suggests that, although recessions pose risks to health, the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe. Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health, yet public health voices have remained largely silent during the economic crisis. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                albacete
                Revista Clínica de Medicina de Familia
                Rev Clin Med Fam
                Sociedad Española de Medicina de Familia y Comunitaria (Barcelona, Cataluña, Spain )
                1699-695X
                2386-8201
                2021
                : 14
                : 2
                : 57-63
                Affiliations
                [1] Madrid Madrid orgnameUniversidad Rey Juan Carlos orgdiv1Facultad de Ciencias de la Salud Spain
                [2] Madrid orgnameServicio Madrileño de Salud orgdiv1Gerencia Asistencial de Atención Primaria orgdiv2Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Oeste España
                Article
                S1699-695X2021000200004 S1699-695X(21)01400200004
                d383c421-635a-446d-9060-efce217a9d3a

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 06 May 2021
                : 20 April 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 7
                Product

                SciELO Spain

                Categories
                Originales

                enfermedad crónica,Spain,social class,population characteristics,health status,economic crisis,chronic disease,características de la población,clase social,España,crisis económica,estado de salud

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