Economic Crisis Impact and Social Determinants of Perinatal Outcomes and Infant Mortality in Greece

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2020 Sep 16

PMID 32932859

Citations 12

Authors

Christos Zilidis

Christos Hadjichristodoulou

Affiliations

Soon will be listed here.

Abstract

(1) Background: To explore the effects of the 2008 economic crisis on maternal, perinatal and infant mortality in Greece and the socio-economic determinants associated with them; (2) Methods: The annual rates of stillbirth (SBR), perinatal mortality (PMR), infant mortality (IMR), neonatal mortality (NNMR), post-neonatal mortality (PNMR), low birth weight (LBW), and maternal mortality (MMR) were calculated for the years 2000-2016. Average Annual Percent Changes (AAPC) were calculated by the period before and after 2008. The expected rates of 2009-2016 and the observed-to-expected rate ratios (RR) were calculated. Correlation and multiple linear regression analyses were used to test the impact of socio-economic variables on health outcomes; (3) Results: A reverse in downwards trends of PNM, IMR, and NNMR is observed since 2009. All observed values of 2009-2016 were found significantly higher than the expected ones by 12-34%. All indicators except SBR were found negatively correlated with GDP and DHI. A positive correlation was found between IMR, NNMR, and LBW and long-term unemployment, and no association with public health expenditure; (4) Conclusions: Economic crisis was associated with remarkable adverse effects on perinatal outcomes and infant mortality, mainly determined by long-term unemployment and income reduction. The findings stress a need for interventions to protect maternity and child health during crises.

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References

Rajmil L, Taylor-Robinson D, Gunnlaugsson G, Hjern A, Spencer N . Trends in social determinants of child health and perinatal outcomes in European countries 2005-2015 by level of austerity imposed by governments: a repeat cross-sectional analysis of routinely available data. BMJ Open. 2018; 8(10):e022932. PMC: 6194462. DOI: 10.1136/bmjopen-2018-022932. View

Baker P, Hone T, Reeves A, Avendano M, Millett C . Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013. Health Econ Policy Law. 2018; 14(2):249-273. DOI: 10.1017/S1744133118000269. View

Zografaki I, Papamichail D, Panagiotopoulos T . Adverse effect of the financial crisis in Greece on perinatal factors. Eur J Public Health. 2018; 28(6):1116-1121. DOI: 10.1093/eurpub/cky078. View

Drydakis N . The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: a longitudinal study before and during the financial crisis. Soc Sci Med. 2015; 128:43-51. DOI: 10.1016/j.socscimed.2014.12.025. View

Kana M, Correia S, Peleteiro B, Severo M, Barros H . Impact of the global financial crisis on low birth weight in Portugal: a time-trend analysis. BMJ Glob Health. 2017; 2(2):e000147. PMC: 5435250. DOI: 10.1136/bmjgh-2016-000147. View

Laliotis I, Ioannidis J, Stavropoulou C . Total and cause-specific mortality before and after the onset of the Greek economic crisis: an interrupted time-series analysis. Lancet Public Health. 2017; 1(2):e56-e65. DOI: 10.1016/S2468-2667(16)30018-4. View

Wilson-Mitchell K, Rummens J . Perinatal outcomes of uninsured immigrant, refugee and migrant mothers and newborns living in Toronto, Canada. Int J Environ Res Public Health. 2013; 10(6):2198-213. PMC: 3717732. DOI: 10.3390/ijerph10062198. View

Margerison-Zilko C, Goldman-Mellor S, Falconi A, Downing J . Health Impacts of the Great Recession: A Critical Review. Curr Epidemiol Rep. 2016; 3(1):81-91. PMC: 4880023. DOI: 10.1007/s40471-016-0068-6. View

Bruckner T, Cheng Y, Singh A, Caughey A . Economic downturns and male cesarean deliveries: a time-series test of the economic stress hypothesis. BMC Pregnancy Childbirth. 2014; 14:198. PMC: 4059074. DOI: 10.1186/1471-2393-14-198. View

10.

Huang L, Sauve R, Birkett N, Fergusson D, van Walraven C . Maternal age and risk of stillbirth: a systematic review. CMAJ. 2008; 178(2):165-72. PMC: 2175002. DOI: 10.1503/cmaj.070150. View

11.

Almli L, Ely D, Ailes E, Abouk R, Grosse S, Isenburg J . Infant Mortality Attributable to Birth Defects - United States, 2003-2017. MMWR Morb Mortal Wkly Rep. 2020; 69(2):25-29. PMC: 6973351. DOI: 10.15585/mmwr.mm6902a1. View

12.

Vlachadis N, Kornarou E . Increase in stillbirths in Greece is linked to the economic crisis. BMJ. 2013; 346:f1061. DOI: 10.1136/bmj.f1061. View

13.

Onambele L, San Martin-Rodriguez L, Niu H, Alvarez-Alvarez I, Arnedo-Pena A, Guillen-Grima F . [Infant mortality in the European Union: A time trend analysis of the 1994-2015 period]. An Pediatr (Engl Ed). 2019; 91(4):219-227. DOI: 10.1016/j.anpedi.2018.10.022. View

14.

Rajmil L, Fernandez de Sanmamed M, Choonara I, Faresjo T, Hjern A, Kozyrskyj A . Impact of the 2008 economic and financial crisis on child health: a systematic review. Int J Environ Res Public Health. 2014; 11(6):6528-46. PMC: 4078594. DOI: 10.3390/ijerph110606528. View

15.

Lassi Z, Bhutta Z . Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev. 2015; (3):CD007754. PMC: 8498021. DOI: 10.1002/14651858.CD007754.pub3. View

16.

Carlson K . Fear itself: The effects of distressing economic news on birth outcomes. J Health Econ. 2015; 41:117-32. DOI: 10.1016/j.jhealeco.2015.02.003. View

17.

Reno R, Hyder A . The Evidence Base for Social Determinants of Health as Risk Factors for Infant Mortality: A Systematic Scoping Review. J Health Care Poor Underserved. 2018; 29(4):1188-1208. DOI: 10.1353/hpu.2018.0091. View

18.

Sdona E, Papamichail D, Ragkou E, Briana D, Malamitsi-Puchner A, Panagiotopoulos T . Greek economic crisis and impaired perinatal parameters: experience from a public maternity hospital. J Matern Fetal Neonatal Med. 2017; 31(18):2371-2375. DOI: 10.1080/14767058.2017.1342803. View

19.

Sugai M, Gilmour S, Ota E, Shibuya K . Trends in perinatal mortality and its risk factors in Japan: Analysis of vital registration data, 1979-2010. Sci Rep. 2017; 7:46681. PMC: 5404230. DOI: 10.1038/srep46681. View

20.

Siahanidou T, Dessypris N, Analitis A, Mihas C, Evangelou E, Chrousos G . Disparities of infant and neonatal mortality trends in Greece during the years of economic crisis by ethnicity, place of residence and human development index: a nationwide population study. BMJ Open. 2019; 9(8):e025287. PMC: 6701607. DOI: 10.1136/bmjopen-2018-025287. View