RT Journal Article SR Electronic T1 Changes in directly alcohol-attributable mortality during the great recession by employment status in Spain: a population cohort of 22 million people JF Journal of Epidemiology and Community Health JO J Epidemiol Community Health FD BMJ Publishing Group Ltd SP jech-2016-208759 DO 10.1136/jech-2016-208759 A1 Ignacio Alonso A1 Fernando Vallejo A1 Enrique Regidor A1 M José Belza A1 Luis Sordo A1 Laura Otero-García A1 Gregorio Barrio YR 2017 UL http://jech.bmj.com/content/early/2017/04/17/jech-2016-208759.abstract AB Background Macroeconomic fluctuations can impact differentially on alcohol-related problems across sociodemographic groups. We assess trend changes in directly alcohol-attributable (DAA) mortality in the population aged 25–64 during the post-2008 recession in Spain according to employment status and other sociodemographic factors.Methods Nationwide cohort study covering 21.9 million people living in Spain in 2001. People were classified by employment status and other factors. The annual percentage change (APC) in mortality rates during 2002–2007 (precrisis) and 2008–2011 (crisis) was estimated by the Poisson regression. The period effect size was then calculated as the difference between crisis and precrisis APCs.Results The age-adjusted APCs in DAA mortality were 6.9% in 2002–2007 and 3.7% in 2008–2011 among employed people, and −4.3% and −0.4%, respectively, among non-employed people. Statistically significant trend changes in such mortality during the crisis were found, which were favourable in certain employed subgroups (manual workers and employees aged 25–49), and unfavourable in the total non-employed population and certain non-employed subgroups (men, non-married and especially medium/high-wealth people). The greatest unfavourable change corresponded to non-employed people living in households of 72–104 m2 who had 2 or more cars. Favourable changes were also found in the remaining employed subgroups, especially women and non-married people, although they did not reach statistical significance.Conclusions Our findings suggest that the post-2008 Spanish crisis had a heterogeneous impact across sociodemographic subgroups on DAA mortality, and that employment status seemed to have an important effect. The impact was especially unfavourable on the non-employed, particularly those with substantial material wealth.