Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
Mortality Register of the Valencian Community, section of Epidemiological Studies and Health Statistics, General Sub-directorate of Epidemiology and Health Monitoring, General Directorate of Public Health, Health Ministry of the Valencian Government, 03010 Alicante, Spain.
Int J Environ Res Public Health. 2018 Oct 19;15(10):2298. doi: 10.3390/ijerph15102298.
Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects on the health of the population are still ongoing. While on the one hand, some evidence associates the economic crisis with positive health outcomes (pro-cyclical effect), on the other hand, some other evidence suggests that the economic crisis may pose serious public health problems (counter-cyclical effect), which has given rise to controversy. To describe the evolution of overall mortality and amenable mortality in Spain between 2002⁻2007 (before the economic crisis) and 2008⁻2013 (during the economic crisis), nationally and by province, as well as to analyse trends in the risks of death and their association with indicators of the impact of the crisis. Ecological study of overall mortality and amenable mortality describing the evolution of the risks of death between 2002⁻2007 and 2008⁻2013. Age Standardised Rates were calculated, as well as their percentage change between periods. The association between percentage changes and provincial indicators of the impact of the crisis was analysed. Amenable mortality was studied both overall and categorised into five groups. Amenable mortality represented 8.25% of overall mortality in 2002⁻2007, and 6.93% in 2008⁻2013. Age Standardised Rates for overall mortality and global amenable mortality generally declined, with the sharpest decline in amenable mortality. Decreases in overall mortality and amenable mortality were directly related to vulnerability indicators. The most significant decreases were registered in ischaemic heart disease, cerebrovascular disease, and other amenable causes. The relationship with vulnerability indices varied from direct (cancer) to inverse (hypertensive disease). Amenable mortality shows a more significant decrease than overall mortality between both study periods, albeit unevenly between provinces causes of death. Higher vulnerability indicators entail greater declines, although this trend varied for different causes. Mortality trends and their relationship with socioeconomic indicators in a situation of crisis must be conducted cautiously, taking into consideration a possible pro-cyclical effect.
近年来，大多数欧洲国家的总体死亡率和可避免死亡率都有所下降。显然，社会经济地位较低的群体死亡风险更高。2008 年，大多数国家陷入严重的经济衰退，其对人口健康的影响仍在持续。一方面，一些证据表明经济危机对健康有积极影响（顺周期性效应），另一方面，另一些证据表明经济危机可能带来严重的公共卫生问题（逆周期性效应），这引发了争议。
本研究旨在描述西班牙 2002-2007 年（经济危机前）和 2008-2013 年（经济危机期间）总体死亡率和可避免死亡率的变化情况，按省份和全国范围进行分析，并分析死亡风险的变化趋势及其与危机影响指标的关系。
本研究采用总体死亡率和可避免死亡率的生态研究方法，描述了 2002-2007 年和 2008-2013 年期间死亡风险的变化情况。计算了年龄标准化率及其期间的百分比变化。分析了省级危机影响指标与百分比变化之间的关系。可避免死亡率总体上和按五个类别进行了研究。
2002-2007 年，可避免死亡率占总体死亡率的 8.25%，2008-2013 年为 6.93%。总体死亡率和全球可避免死亡率的年龄标准化率普遍下降，其中可避免死亡率下降幅度最大。总体死亡率和可避免死亡率的下降与脆弱性指标直接相关。缺血性心脏病、脑血管疾病和其他可避免原因的死亡率下降最为显著。与脆弱性指数的关系从直接（癌症）到相反（高血压疾病）不等。
与两个研究期间相比，可避免死亡率的下降幅度大于总体死亡率，尽管各省之间的死因下降幅度不均。较高的脆弱性指标意味着更大的下降，尽管这种趋势因不同的病因而异。在危机情况下，必须谨慎地进行死亡率趋势及其与社会经济指标的关系研究，同时考虑可能的顺周期性效应。
