Introduction:
The effects of economic crisis, like the current recession affecting Europe since 2008, on health have been widely debated. Our objective was to evaluate the effects of economic changes on mortality trends from ischemic heart disease (IHD) in Europe for the period 1980-2010.
Hypothesis:
We hypothesize that economic recession is associated with either increases in IHD mortality rates or halting of previous declining trends.
Methods:
We gathered economic (World Bank) and vital statistics data (WHO Mortality Database) for all Western European countries with more than 5 million inhabitants that had complete mortality data for the period 1980-2010. We defined a period of economic recession as an annual GDP (Gross Domestic Product) growth below 0%. We also computed the cumulative years lived through a given recession period (set to 0 if GDP growth rises above 0% in a given year). We computed age-adjusted (2013 European Standard Population) mortality rates for IHD (ICD9 Codes: 410-414, ICD10 Codes: I20-I25) for the study period and computed yearly changes. We modelled the association between recession and IHD mortality using Generalized Estimating Equations accounting for the correlation among data within country and time using first order autoregressive within-group correlation structures. Changes in ICD coding were introduced as a covariate to account for the shift from ICD-9 to ICD-10. We tested for associations using 0 to 10 year lags. Sensitivity analyses were conducted using unemployment as an alternative indicator of economic recession.
Results:
Twelve Western European countries were included (Austria, Finland, France, Germany, Greece, Ireland, Netherlands, Norway, Spain, Sweden, Switzerland and the United Kingdom). Economic recession was associated with a 2-year lagged 1.49% increase in IHD mortality in men (p=0.016) and 1.74% increase in women (p=0.019). Each additional year of recession was associated with a 2-year lagged 1.21% increase in IHD mortality in men (p=0.003) and 1.17% increase in women (p=0.016). Sensitivity analyses using unemployment as a second measure of economic recession showed analogous results with strongest associations seen in 0-year lags. GDP and Unemployment were highly correlated with two-year lags between GDP and Unemployment changes, confirming the robustness of these associations.
Conclusions:
This study showed a deleterious effect of economic recession on ischemic heart disease mortality rates in Europe for the period 1980-2010. Further studies should look into the specific mechanisms of this association and into the possible interaction with policy responses to economic crisis.
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Trends in ischemic heart disease mortality rates, selected EU countries, 2000-13
