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Changes in directly alcohol-attributable mortality during the great recession by employment status in Spain: a population cohort of 22 million people
  1. Ignacio Alonso1,
  2. Fernando Vallejo2,3,
  3. Enrique Regidor3,4,
  4. M José Belza1,3,
  5. Luis Sordo2,3,4,
  6. Laura Otero-García3,5,
  7. Gregorio Barrio1
  1. 1 National School of Public Health, Carlos III Health Institute, Madrid, Spain
  2. 2 National Epidemiology Center, Carlos III Health Institute, Madrid, Spain
  3. 3 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
  4. 4 Department of Preventive Medicine and Public Health, Madrid Complutense University, Madrid, Spain
  5. 5 Departmental Nursing Section, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
  1. Correspondence to Dr María José Belza, National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, Madrid E-28029, Spain; mbelza{at}


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.

  • Cohort studies

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  • Contributors GB coordinated the design of the study and writing of the article; IA and FV carried out the statistical analysis and reviewed the consistency of data included in the paper; LS and LO-G carried out the bibliographic searches and elaborated the theoretical framework. MJB wrote the first draft of the manuscript in collaboration with IA. ER performed the interpretation of the results and wrote the final version of article in collaboration with GB and MJB. All authors critically reviewed, approved the final version. Also all authors believe in the overall validity of the paper and take public responsibility for its contents.

  • Funding This work was supported by the Spanish Health Research and Development Strategy (PI15CIII/00022) and National Plan on Drugs (2015I040). Writing the paper was also partially supported by the ISCIII Network on Addictive Disorders (Networks for Cooperative Research in the Carlos III Health Institute) (grant numbers RD16/0017/0013 and RD12/0028/0018).

  • Competing interests None declared.

  • Ethics approval Institutional Review Board of the National Institute of Statistics (INE).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Study data are currently not available for sharing.