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Macroeconomic fluctuations, changes in lifestyles and mortality from diabetes: a quasiexperimental study
  1. Enrique Regidor1,2,3,
  2. Romana Albaladejo1,
  3. Alberto Mateo4,5,
  4. Luis de la Fuente2,5,
  5. Gregorio Barrio6,
  6. Paloma Ortega1,3
  1. 1 Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
  2. 2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  3. 3 Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
  4. 4 School of Public Health, Health Education North West, Manchester, UK
  5. 5 National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
  6. 6 National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
  1. Correspondence to Dr Enrique Regidor, Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, Madrid 28040, Spain; enriqueregidor{at}


Background To evaluate trends in diabetes-related health behaviours and mortality from diabetes and other chronic diseases in the Spanish population before, during and after the 2008 economic crisis.

Methods Annual population measurements were obtained from national surveys and administrative registries for 2004–2016. Using segmented regression analysis, we calculated the annual percentage change (APC) in 2004–2007, 2008–2010, 2011–2013 and 2014–2016 in risk behaviours (smoking, alcohol consumption, obesity and meals away from home), in healthy behaviours (fruit and vegetable intake and physical activity) and in mortality rates from diabetes, cardiovascular disease and cancer.

Results In general, during the economic crisis (2008–2013), the Spanish population reduced risk behaviours and improved healthy behaviours as compared with the trend observed before and afterwards. Diabetes mortality decreased more during the crisis than before or afterwards. The APC in each time interval was −3.3, –3.7, −4.4 and −2.6 in all-age mortality and −2.9, –5.2, −6.7 and −1.3 in premature mortality (less than 75 years). Only in older people (≥75 years) diabetes mortality showed similar decline before and during the crisis. Mortality from cardiovascular disease also declined more during the crisis, except for all-age mortality and older people in the second part of the crisis, whereas the downward trend in cancer mortality was smaller during the crisis years.

Conclusions During the 6 years of the economic crisis in Spain, the favourable changes in health behaviours were accompanied by an important reduction in diabetes mortality in the population.

  • diabetes
  • epidemiology
  • lifestyle
  • socio-economic

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  • Contributors ER originated and designed the study and coordinated the writing of the article. RA and PO contributed to the analysis of the data and to the drafting of the paper. AM and GB contributed to the interpretation of the results and to the drafting of the paper. LdlF contributed to the design of the study and to the drafting of the paper. All authors contributed to the final version of the article. All authors have seen and approved the final version. ER is guarantor.

  • Funding Supported by a grant from the Instituto de Salud Carlos III (PI16/00455) and the European Regional Development Fund.

  • Competing interests None declared.

  • Patient consent Not required.

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