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2008 economic crisis impact on perinatal and infant mortality in Southern European countries
  1. Julia Nadine Doetsch1,2,3,
  2. Ricardo Almendra4,
  3. Milton Severo1,3,5,
  4. Teresa Leão1,3,6,
  5. Eva Pilot7,
  6. Thomas Krafft7,
  7. Henrique Barros1,3,6
  1. 1 Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal
  2. 2 Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
  3. 3 Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
  4. 4 CEGOT-Centre of Studies on Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
  5. 5 Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
  6. 6 Predictive Medicine and Public Health Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
  7. 7 Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, Netherlands
  1. Correspondence to Julia Nadine Doetsch, EPIUnit, University of Porto Institute of Public Health, Porto, Portugal; jndoetsch{at}


Introduction The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems’ response to the protection of the health of the most vulnerable groups.

Objective To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain.

Methods Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models.

Results IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018.

Conclusion Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population’s health from the earliest days.

  • public health
  • epidemiology
  • health policy
  • health services
  • health inequalities

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors JND: (guarantor) conceptualisation, methodology, formal analysis, investigation, writing—original draft, writing—review and editing, visualisation. RA: methodology, formal analysis, writing—original draft, writing—review and editing. MS: methodology, formal analysis; writing—review and editing. TL: methodology, writing—review and editing. EP and TK: writing—review and editing. HB: methodology, writing—review and editing, supervision, project administration, funding acquisition.

  • Funding The study received funding from the Foundation for Science and Technology (FCT) (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) and the Laboratório Associado (ITR) (UIDB/04750/2020 e LA/P/0064/2020). This study was also funded by the external PhD programme of Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), the Netherlands. The salary of JND was paid during the initial phase of the study by the RECAP preterm project which has received funding from the European Union’s Horizon 2020 Research and Innovation programme under grant agreement number 733280.

  • Competing interests None declared.

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

  • © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.