The 2008 economic crisis’ impact on perinatal and infant mortality in Southern European countries

Background and objective: The study of crises events provides important lessons to prepare for upcoming events. The Great Recessions impact on perinatal health in Europe can provide relevant insights on the healthcare and social protection systems’ response in the protection of the health of the most vulnerable groups. To assess time trends and international disparities in perinatal (PMR) and infant mortality (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 trends changes between 2000 and 2018. Country disparities were analysed using Mixed Effect 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 necessity to strengthen social protection systems and healthcare systems to better protect the population health from the earliest days.