Medium-term impact of the economic crisis on mortality, health-related behaviours and access to healthcare in Greece

Abstract

Previous studies on the health consequences of the crisis in Greece investigated short-term impacts on selected outcomes. This study examined the impact of the crisis on a key set of health indicators with longer follow up than previous studies. We conducted interrupted time series (ITS) analysis to compare trends in standardised mortality by cause before and during the crisis. We examined changes in fruit and vegetable consumption, smoking, physical activity, obesity, out-of-pocket payments and unmet needs for healthcare using national household data from the "Hellas Health" surveys. Standardised mortality rates for suicides (p < 0.001) and infant mortality (p = 0.003) increased during the crisis compared to pre-existing trends, while mortality from respiratory diseases (p = 0.053) and transport accidents (p = 0.067) decreased. The prevalence of smoking (42.6% to 36.5%; RR = 0.86) and sedentary lifestyle (43.4% to 29.0%; RR = 0.69) declined. The prevalence of unmet need for healthcare significantly increased from 10.0% to 21.9% (RR = 2.10) and the proportion of people paying out-of-pocket for healthcare from 34.4% to 58.7% (RR = 1.69) between 2010 and 2015. The impact of the economic crisis in Greece on health was more nuanced than previous reports suggest. Effective strategies to mitigate the adverse health impacts of economic crises need to be better understood and implemented.

Figure 1. Average annual changes in standardised mortality (per 100,000) by selected causes of death in Greece, before and during the crisis.

*The star indicates a statistically significant (p < 0.05) change in slopes before and during the crisis, based on the interrupted time series analysis. Average annual change of standardised mortality from all causes during the crisis was calculated for years 2010 to 2015. Respiratory diseases include ICD-9 codes 460–519 and ICD-10 codes J00-J98; all neoplasms include ICD-9 codes 140-239 and ICD-10 codes C00-D48; cardiovascular diseases include ICD-9 codes 390–459 and ICD-10 codes I00-I99; ischaemic heart disease include ICD-9 codes 410–414 and ICD-10 codes I20–I25; cerebrovascular disease include ICD-9 codes 430–438 and ICD-10 codes I60–I69; hypertensive disease include ICD-9 codes 401–405 and ICD-10 codes I10–I15; external causes include ICD-9 codes e800-e999 and ICD-10 codes V01-Y89; transport accidents include ICD-9 codes E800-E848 and ICD-10 codes V01-V99, Y85; suicides and self-inflicted injury include ICD-9 codes E950-E959 and ICD-10 codes X64-X84, Y870; homicide and injury purposely inflicted by other persons include ICD-9 codes E960-E969 and ICD-10 codes X85-Y09, Y871; signs, symptoms and ill- defined conditions include ICD-9 codes 780–799 and ICD-10 codes R00–R99; diseases of the digestive system include ICD-9 codes 520–579 and ICD-10 codes K00–K92; and diseases of the urinary system include ICD-9 codes 580–629 and ICD-10 codes N00–N98.

Figure 2. Crude birth rate, still births and infant mortality in Greece, 2001–2015.

Figure 3. Health-related quality of life in Greece, 2008–2015.

MCS-12: Mental composite score of SF12; PCS-12: Physical composite score of SF12.