School of Economics, Faculty of Arts and Social Sciences, University of Surrey, Guildford, UK.
Stanford Prevention Research Center, Department of Medicine, and Department of Hygiene and Epidemiology, School of Medicine, Stanford University, Stanford, CA, USA.
Lancet Public Health. 2016 Dec;1(2):e56-e65. doi: 10.1016/S2468-2667(16)30018-4. Epub 2016 Nov 5.
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.
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希腊是欧洲 2008 年金融危机受灾最严重的国家之一。然而，关于这场危机对总死亡率和死因死亡率的影响，目前仍未有定论。我们研究了经济危机是否会影响整体和死因死亡率的趋势。
我们使用来自希腊统计局的区域面板数据，评估了 2001 年 1 月至 2013 年 12 月期间希腊各年龄段、性别、地区和死因的死亡率趋势。我们使用欧盟统计局的数据计算了每个地区每月每 10 万人年龄标准化死亡率。数据分为两个子时段：危机前（2001 年 1 月至 2008 年 8 月）和危机后（2008 年 9 月至 2013 年 12 月）。我们通过中断时间序列分析来检验死亡率斜率是否发生变化。
金融危机爆发后，总死亡率持续下降（-0.065，95%CI -0.080 至-0.049），但下降速度比危机前（-0.13，-0.15 至-0.10；趋势差异 0.062，95%CI 0.041 至 0.083；p<0.0001）慢。这种趋势差异在女性中更为明显（0.087，95%CI 0.064-0.11；p<0.0001），而在男性中则不明显（0.040，0.013-0.066；p=0.007）。至少 75 岁的人群受到的影响更为严重（趋势差异 0.056，95%CI 0.042 至 0.071；p<0.0001），而 20-34 岁人群的死亡率趋势则有所改善（-0.0074，-0.0089 至-0.0059；p<0.0001）。与危机前相比，心血管疾病的死亡率下降速度更为缓慢（趋势差异 0.043，95%CI 0.024 至 0.063；p<0.0001），而车辆事故导致的死亡率则下降得更快（-0.0062，-0.0090 至-0.0033；p<0.0001），尤其是在 20-34 岁的男性中（-0.0065，-0.0085 至-0.0044；p<0.0001）。相反，自杀（趋势差异 0.0021，95%CI 0.00092-0.0033；p=0.002）、神经系统疾病（0.0036，0.0016 至 0.0056；p=0.002）和心理健康问题（0.00073，0.000047 至 0.0014；p=0.038）的死亡率在危机后有所增加。此外，医疗事故导致的死亡率在危机后显著上升（趋势差异 0.0020，95%CI 0.0012-0.0028；p<0.0001）。通过比较危机后时期的预期值和基于危机前时期的外推值，我们估计危机后每月额外增加了 242 例死亡。
与危机前相比，死亡率趋势在危机后发生了中断，但变化因年龄、性别和死因而异。医疗事故导致的死亡率增加可能反映了经济衰退期间医疗质量下降的影响。
在危机后时期，死亡率趋势发生了变化，但变化因年龄、性别和死因而异。医疗事故导致的死亡率增加可能反映了经济衰退期间医疗质量下降的影响。
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