{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T02:06:01Z","timestamp":1769825161654,"version":"3.49.0"},"reference-count":113,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2023,2,5]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession\u2019s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems\u2019 response to the protection of the health of the most vulnerable groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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\u2019s health from the earliest days.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2022-219639","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T13:20:44Z","timestamp":1677072044000},"page":"305-314","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["2008 economic crisis impact on perinatal and infant mortality in Southern European countries"],"prefix":"10.1136","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1388-9542","authenticated-orcid":false,"given":"Julia Nadine","family":"Doetsch","sequence":"first","affiliation":[{"name":"Unidade de Investiga\u00e7\u00e3o em Epidemiologia (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto (ISPUP), Porto, Portugal"},{"name":"Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands"},{"name":"Laborat\u00f3rio para a Investiga\u00e7\u00e3o Integrativa e Translacional em Sa\u00fade Populacional (ITR), Universidade do Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2712-9643","authenticated-orcid":false,"given":"Ricardo","family":"Almendra","sequence":"additional","affiliation":[{"name":"CEGOT-Centre of Studies on Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal"}]},{"given":"Milton","family":"Severo","sequence":"additional","affiliation":[{"name":"Unidade de Investiga\u00e7\u00e3o em Epidemiologia (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto (ISPUP), Porto, Portugal"},{"name":"Laborat\u00f3rio para a Investiga\u00e7\u00e3o Integrativa e Translacional em Sa\u00fade Populacional (ITR), Universidade do Porto, Porto, Portugal"},{"name":"Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar, Universidade do Porto, Porto, Portugal"}]},{"given":"Teresa","family":"Le\u00e3o","sequence":"additional","affiliation":[{"name":"Unidade de Investiga\u00e7\u00e3o em Epidemiologia (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto (ISPUP), Porto, Portugal"},{"name":"Laborat\u00f3rio para a Investiga\u00e7\u00e3o Integrativa e Translacional em Sa\u00fade Populacional (ITR), Universidade do Porto, Porto, Portugal"},{"name":"Predictive Medicine and Public Health Departamento de Ci\u00eancias da Sa\u00fade P\u00fablica e Forenses e Educa\u00e7\u00e3o M\u00e9dica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal"}]},{"given":"Eva","family":"Pilot","sequence":"additional","affiliation":[{"name":"Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, Netherlands"}]},{"given":"Thomas","family":"Krafft","sequence":"additional","affiliation":[{"name":"Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4699-6571","authenticated-orcid":false,"given":"Henrique","family":"Barros","sequence":"additional","affiliation":[{"name":"Unidade de Investiga\u00e7\u00e3o em Epidemiologia (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto (ISPUP), Porto, Portugal"},{"name":"Laborat\u00f3rio para a Investiga\u00e7\u00e3o Integrativa e Translacional em Sa\u00fade Populacional (ITR), Universidade do Porto, Porto, Portugal"},{"name":"Predictive Medicine and Public Health Departamento de Ci\u00eancias da Sa\u00fade P\u00fablica e Forenses e Educa\u00e7\u00e3o M\u00e9dica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"key":"2025100520161711000_77.5.305.1","unstructured":"Euronews . Eurozone heading into recession at the end of this year, brussels says 2022. Available: https:\/\/www.euronews.com\/my-europe\/2022\/11\/11\/europes-record-inflation-will-peak-at-year-end-but-remain-high-in-2023-says-brussels [Accessed 4 Jan 2023]."},{"key":"2025100520161711000_77.5.305.2","unstructured":"Publico . EU faces winter recession as war pummels the economy 2022. Available: https:\/\/www.politico.eu\/article\/eu-winter-recession-growth-euro-area-ukraine-war-invasion-inflation-energy-crisis\/ [Accessed 11 Jan 2023]."},{"key":"2025100520161711000_77.5.305.3","unstructured":"Thomas S , Sagan A , Larkin J , et al . Strengthening health systems resilience, key concepts and strategies. In: European Observatory of Health Systems and Policies. WHO, 2020: 33."},{"key":"2025100520161711000_77.5.305.4","doi-asserted-by":"crossref","unstructured":"Cader AA , Perera L . Understanding the impact of the economic crisis on child and maternal health among the poor: opportunities for South Asia. SSRN Journal 2012. doi:10.2139\/ssrn.1876324 Available: https:\/\/doi.org\/10.2139\/ssrn.1876324","DOI":"10.2139\/ssrn.1876324"},{"key":"2025100520161711000_77.5.305.5","unstructured":"European Commission . COMMUNICATION FROM THE COMMISSION on effective, accessible and resilient health systems. Brussels, 2014."},{"key":"2025100520161711000_77.5.305.6","first-page":"77","article-title":"Lessons from the last financial crisis and the future role of institutional investors","volume":"2011","author":"Rohde","year":"2011","journal-title":"OECD Journal"},{"key":"2025100520161711000_77.5.305.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12992-020-00645-5","article-title":"Assessing COVID-19 through the lens of health systems\u2019 preparedness: time for a change","volume":"16","author":"El Bcheraoui","year":"2020","journal-title":"Global Health"},{"key":"2025100520161711000_77.5.305.8","unstructured":"EU Expert Group on Health Systems Performance Assessment (HSPA) . Assessing the resilience of health systems in europe: an overview of the theory, current practice and strategies for improvement. 2020. Available: https:\/\/doi.org\/10.2875\/191483"},{"key":"2025100520161711000_77.5.305.9","doi-asserted-by":"crossref","first-page":"1986","DOI":"10.1111\/1462-2920.15029","article-title":"The COVID-19 pandemic: some lessons learned about crisis preparedness and management, and the need for international benchmarking to reduce deficits","volume":"22","author":"Timmis","year":"2020","journal-title":"Environ Microbiol"},{"key":"2025100520161711000_77.5.305.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2016-000157","article-title":"Effects of economic downturns on child mortality: a global economic analysis, 1981-2010","volume":"2","author":"Maruthappu","year":"2017","journal-title":"BMJ Glob Health"},{"key":"2025100520161711000_77.5.305.11","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17186606","article-title":"Economic crisis impact and social determinants of perinatal outcomes and infant mortality in greece","volume":"17","author":"Zilidis","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025100520161711000_77.5.305.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2016-000147","article-title":"Impact of the global financial crisis on low birth weight in Portugal: a time-trend analysis","volume":"2","author":"Kana","year":"2017","journal-title":"BMJ Glob Health"},{"key":"2025100520161711000_77.5.305.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-022-01806-1","article-title":"A scoping review on the impact of austerity on healthcare access in the european union: rethinking austerity for the most vulnerable","volume":"22","author":"Doetsch","year":"2023","journal-title":"Int J Equity Health"},{"key":"2025100520161711000_77.5.305.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-017-0679-7","article-title":"Potential barriers in healthcare access of the elderly population influenced by the economic crisis and the troika agreement: a qualitative case study in lisbon, portugal","volume":"16","author":"Doetsch","year":"2017","journal-title":"Int J Equity Health"},{"key":"2025100520161711000_77.5.305.15","doi-asserted-by":"crossref","DOI":"10.1093\/eurpub\/ckz186.006","article-title":"Impact of macro-socioeconomic determinants on perinatal healthcare quality for very preterm infants","volume":"29","author":"Doetsch","year":"2019","journal-title":"Eur J Public Health"},{"key":"2025100520161711000_77.5.305.16","doi-asserted-by":"crossref","first-page":"112451","DOI":"10.1016\/j.socscimed.2019.112451","article-title":"Does economic recession impact newborn health? Evidence from Greece","volume":"237","author":"Kyriopoulos","year":"2019","journal-title":"Soc Sci Med"},{"key":"2025100520161711000_77.5.305.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-016-2720-y","article-title":"Mental health outcomes in times of economic recession: A systematic literature review","volume":"16","author":"Frasquilho","year":"2016","journal-title":"BMC Public Health"},{"key":"2025100520161711000_77.5.305.18","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/pubmed\/fdab129","article-title":"The impact of economic crisis on mortality due to mental health illnesses","volume":"44","author":"Zilidis","year":"2022","journal-title":"J Public Health (Oxf)"},{"key":"2025100520161711000_77.5.305.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2014.02.014"},{"key":"2025100520161711000_77.5.305.20","doi-asserted-by":"crossref","unstructured":"Drydakis N , Anglia Ruskin University . The relationship between recessions and health. Izawol 2016:1\u20139. doi:10.15185\/izawol.283","DOI":"10.15185\/izawol.283"},{"key":"2025100520161711000_77.5.305.21","doi-asserted-by":"crossref","unstructured":"Serapioni M , Hespanha P . Crisis and austerity in southern europe: impact on economies and societies. Eces 2019. doi:10.4000\/eces.4068 Available: http:\/\/journals.openedition.org\/eces\/4043","DOI":"10.4000\/eces.4068"},{"key":"2025100520161711000_77.5.305.22","unstructured":"Leventi C , Paulus A , Matsaganis M , et al . The distributional effects of austerity measures: a comparison of six EU countries. EUROMOD working papers EM6\/11. EUROMOD at the Institute for Social and Economic Research, 2011."},{"key":"2025100520161711000_77.5.305.23","unstructured":"Hespanha P . As reformas dos sistemas de sa\u00fade na europa do sul: crises e alternativas. In: Rodrigues PH , Santos I , eds. Pol\u00edticas e riscos sociais no Brasil e na Europa: converg\u00eancias e diverg\u00eancias. Rio de Janeiro: HUCITEC Ed, 2017: 81\u2013110."},{"key":"2025100520161711000_77.5.305.24","unstructured":"Rodrigues R , Schulmann K . Impacts of the crisis on access to healthcare services: country report on Portugal 1. Policy context in Portugal. 2014."},{"key":"2025100520161711000_77.5.305.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2012.04.008"},{"key":"2025100520161711000_77.5.305.26","unstructured":"Parliament D-G for IP-E . The impact of the crisis on fundamental rights across member states of the EU: comparative analysis. 2015;53:160."},{"key":"2025100520161711000_77.5.305.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2015.04.009"},{"key":"2025100520161711000_77.5.305.28","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1080\/13608746.2014.983317","article-title":"The impact of the economic crisis on the ideological space in Portugal and Greece: a comparison of elites and voters","volume":"19","author":"Tsatsanis","year":"2014","journal-title":"South European Society and Politics"},{"key":"2025100520161711000_77.5.305.29","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckv055"},{"key":"2025100520161711000_77.5.305.30","unstructured":"Murray CJL , Frenk J . A WHO framework for health system performance assessment. WHO, 2000."},{"key":"2025100520161711000_77.5.305.31","doi-asserted-by":"crossref","unstructured":"Smith PC , Mossialos E , Papanicolas I , et al . Performance measurement for health system improvement experiences, challenges and prospects. 2010: 675\u2013706. doi:10.1017\/CBO9780511711800","DOI":"10.1017\/CBO9780511711800.024"},{"key":"2025100520161711000_77.5.305.32","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.healthpol.2014.02.002","article-title":"Effects of the economic crisis on health and healthcare in greece in the literature from 2009 to 2013: A systematic review","volume":"115","author":"Simou","year":"2014","journal-title":"Health Policy (New York)"},{"key":"2025100520161711000_77.5.305.33","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-10194-0","article-title":"Impact of macro-socioeconomic determinants on sustainable perinatal health care in portugal: a qualitative study on the opinion of healthcare professionals and experts","volume":"21","author":"Doetsch","year":"2021","journal-title":"BMC Public Health"},{"key":"2025100520161711000_77.5.305.34","unstructured":"Lin JY , President SV , Economist C , et al . The impact of the financial crisis on unmet needs for healthcare. 2013: 1\u201344."},{"key":"2025100520161711000_77.5.305.35","unstructured":"Measure Evalutation . Measure evaluation- family planning and reproductive health indicator database. Available: https:\/\/www.measureevaluation.org\/prh\/rh_indicators\/womens-health\/sm\/maternal-mortality-ratio-mmr [Accessed 11 Feb 2021]."},{"key":"2025100520161711000_77.5.305.36","first-page":"545","article-title":"Perinatal mortality rate as a quality indicator og health care","volume":"13","author":"Santosh","year":"2013","journal-title":"Sultan Qaboos Univ Med"},{"key":"2025100520161711000_77.5.305.37","first-page":"1","volume-title":"Hutchins Cent Fisc Monet Pol Icy Brookings","volume":"43","author":"Dynan","year":"2018"},{"key":"2025100520161711000_77.5.305.38","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.anpede.2019.03.002","article-title":"Infant mortality in the European Union: a time trend analysis of the 1994\u20132015 period","volume":"91","author":"Onambele","year":"2019","journal-title":"Anales de Pediatr\u00eda (English Edition)"},{"key":"2025100520161711000_77.5.305.39","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.gaceta.2014.02.016","article-title":"Impact of the economic crisis on the health of older persons in spain: research clues based on an analysis of mortality. sespas report 2014","volume":"28 Suppl 1","author":"Benmarhnia","year":"2014","journal-title":"Gac Sanit"},{"key":"2025100520161711000_77.5.305.40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s43054-020-00048-6","article-title":"The comparing of infant mortality rate in different world Health organization regions during 1990\u20132017","volume":"69","author":"Esmaeilzadeh","year":"2021","journal-title":"Egypt Pediatric Association Gaz"},{"key":"2025100520161711000_77.5.305.41","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-019-08539-w","article-title":"Effect of the great recession on regional mortality trends in europe","volume":"10","author":"Ballester","year":"2019","journal-title":"Nat Commun"},{"key":"2025100520161711000_77.5.305.42","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1093\/eurpub\/ckaa058","article-title":"Use of amenable mortality indicators to evaluate the impact of financial crisis on health system performance in Greece","volume":"30","author":"Zilidis","year":"2020","journal-title":"Eur J Public Health"},{"key":"2025100520161711000_77.5.305.43","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph110606528"},{"key":"2025100520161711000_77.5.305.44","doi-asserted-by":"publisher","DOI":"10.1177\/003335490912400509"},{"key":"2025100520161711000_77.5.305.45","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s12603-020-1360-1","article-title":"Editorial: urbanization and ageing health outcomes","volume":"24","author":"Michel","year":"2020","journal-title":"J Nutr Health Aging"},{"key":"2025100520161711000_77.5.305.46","doi-asserted-by":"crossref","DOI":"10.1002\/psp.2599","article-title":"Age patterns of net migration and urbanisation dynamics across European municipalities","volume":"29","author":"Ghio","year":"2023","journal-title":"Population Space and Place"},{"key":"2025100520161711000_77.5.305.47","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2015.08.009"},{"key":"2025100520161711000_77.5.305.48","unstructured":"Portugal P , Raposo PS , Reis H . The distribution of wages and wage inequality. Bank Port Econ Stud, 2018."},{"key":"2025100520161711000_77.5.305.49","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1177\/1363459314524803","article-title":"International medical migration: a critical conceptual review of the global movements of doctors and nurses","volume":"18","author":"Bradby","year":"2014","journal-title":"Health (London)"},{"key":"2025100520161711000_77.5.305.50","unstructured":"Jakubowski E , Busse R . Health care systems in the EU: A comparative study. 1998."},{"key":"2025100520161711000_77.5.305.51","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0247413","article-title":"Relationship between mortality and health care expenditure: sustainable assessment of health care system","volume":"16","author":"Owusu","year":"2021","journal-title":"PLoS One"},{"key":"2025100520161711000_77.5.305.52","doi-asserted-by":"publisher","DOI":"10.1257\/app.6.1.91"},{"key":"2025100520161711000_77.5.305.53","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18031242","article-title":"Spatial access matters: an analysis of policy change and its effects on avoidable infant mortality in Portugal","volume":"18","author":"Weiland","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025100520161711000_77.5.305.54","unstructured":"Cesur R , G\u00fcne\u015f PM , Tekin E , et al . The impact of universal primary healthcare provision on. 2015."},{"key":"2025100520161711000_77.5.305.55","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2018.00960","article-title":"The influence of universal health coverage on life expectancy at birth (LEAB) and healthy life expectancy (HALE): a multi-country cross-sectional study","volume":"9","author":"Ranabhat","year":"2018","journal-title":"Front Pharmacol"},{"key":"2025100520161711000_77.5.305.56","doi-asserted-by":"crossref","DOI":"10.1186\/s12960-017-0256-6","article-title":"The effects of austerity measures on quality of healthcare services: a national survey of physicians in the public and private sectors in portugal","volume":"15","author":"Correia","year":"2017","journal-title":"Hum Resour Health"},{"key":"2025100520161711000_77.5.305.57","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-032972","article-title":"Impact of economic recessions on healthcare workers and their crises\u2019 responses: study protocol for a systematic review of the qualitative and quantitative evidence for the development of an evidence-based conceptual framework","volume":"9","author":"Jesus","year":"2019","journal-title":"BMJ Open"},{"key":"2025100520161711000_77.5.305.58","doi-asserted-by":"crossref","first-page":"263","DOI":"10.20344\/amp.7690","article-title":"Economic crisis and portuguese national health service physicians: findings from A descriptive study of their perceptions and reactions from health care units in the greater lisbon area","volume":"30","author":"Rego","year":"2017","journal-title":"Acta Med Port"},{"key":"2025100520161711000_77.5.305.59","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-022932","article-title":"Trends in social determinants of child health and perinatal outcomes in european countries 2005-2015 by level of austerity imposed by governments: a repeat cross-sectional analysis of routinely available data","volume":"8","author":"Rajmil","year":"2018","journal-title":"BMJ Open"},{"key":"2025100520161711000_77.5.305.60","doi-asserted-by":"crossref","unstructured":"Hainsworth J . How the economic and financial crisis is affecting children and young people in Europe. SSRN Journal 2011. doi:10.2139\/ssrn.1761271","DOI":"10.2139\/ssrn.1761271"},{"key":"2025100520161711000_77.5.305.61","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1007\/s00484-019-01700-6","article-title":"Excess winter mortality and morbidity before, during, and after the great recession: the portuguese case","volume":"63","author":"Almendra","year":"2019","journal-title":"Int J Biometeorol"},{"key":"2025100520161711000_77.5.305.62","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph16152647","article-title":"The role of individual and neighborhood characteristics on mental health after A period of economic crisis in the lisbon region (portugal): A multilevel analysis","volume":"16","author":"Loureiro","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2025100520161711000_77.5.305.63","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-016-0483-9"},{"key":"2025100520161711000_77.5.305.64","doi-asserted-by":"crossref","unstructured":"Janke K , Lee K , Propper C , et al . Macroeconomic conditions and health in Britain: aggregation, dynamics and local area heterogeneity. SSRN Journal 2021. doi:10.2139\/ssrn.3562881","DOI":"10.2139\/ssrn.3562881"},{"key":"2025100520161711000_77.5.305.65","doi-asserted-by":"crossref","first-page":"e1575","DOI":"10.1016\/S2214-109X(19)30409-7","article-title":"Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 brazilian municipalities","volume":"7","author":"Hone","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2025100520161711000_77.5.305.66","doi-asserted-by":"publisher","DOI":"10.1016\/j.plrev.2016.07.005.Mathematical"},{"key":"2025100520161711000_77.5.305.67","doi-asserted-by":"publisher","DOI":"10.1007\/s40471-016-0068-6"},{"key":"2025100520161711000_77.5.305.68","doi-asserted-by":"crossref","DOI":"10.1038\/srep46423","article-title":"Medium-term impact of the economic crisis on mortality, health-related behaviours and access to healthcare in greece","volume":"7","author":"Filippidis","year":"2017","journal-title":"Sci Rep"},{"key":"2025100520161711000_77.5.305.69","unstructured":"Johnston M . Understanding the downfall of greece\u2019s economy. Investopia 2022. Available: https:\/\/www.investopedia.com\/articles\/investing\/070115\/understanding-downfall-greeces-economy.asp"},{"key":"2025100520161711000_77.5.305.70","unstructured":"Charalampos Economou . Barriers and facilitating factors in access to health services in greece. Denmark, 2015."},{"key":"2025100520161711000_77.5.305.71","doi-asserted-by":"crossref","unstructured":"Serapioni M , Hespanha P . Crisis and austerity in southern Europe: impact on economies and societies. Eces 2019. doi:10.4000\/eces.4068 Available: http:\/\/journals.openedition.org\/eces\/4043","DOI":"10.4000\/eces.4068"},{"key":"2025100520161711000_77.5.305.72","unstructured":"Thomson S , Figueras J , Evetovits T , et al . In: Economic Crisis, Health Systems and Health in Europe Impact and implications for policy European Observatory on Health Systems and Policies Series. 2015: 1\u201360."},{"key":"2025100520161711000_77.5.305.73","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.worlddev.2013.12.010","article-title":"Consequences of aid volatility for macroeconomic management and aid effectiveness","volume":"69","author":"Hudson","year":"2015","journal-title":"World Development"},{"key":"2025100520161711000_77.5.305.74","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-015-0468-7","article-title":"The socio-economic determinants of infant mortality in nepal: analysis of nepal demographic health survey, 2011","volume":"15","author":"Khadka","year":"2015","journal-title":"BMC Pediatr"},{"key":"2025100520161711000_77.5.305.75","unstructured":"Veiga P . Working paper series income-related health inequality in Portugal. 2005."},{"key":"2025100520161711000_77.5.305.76","unstructured":"European Commission - Direcorate-General for Economic and Financial Affairs . Impact of the current economic and financial crisis on potential ouput. 2009. Available: https:\/\/doi.org\/10.2765\/44883"},{"key":"2025100520161711000_77.5.305.77","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2013.09.005"},{"key":"2025100520161711000_77.5.305.78","doi-asserted-by":"crossref","first-page":"110860","DOI":"10.1016\/j.econlet.2022.110860","article-title":"Recessions and mortality: a global perspective","volume":"220","author":"Doerr","year":"2022","journal-title":"Economics Letters"},{"key":"2025100520161711000_77.5.305.79","unstructured":"Leahy A , Healy S , Murphy M . The impact of the european crisis. A study of the impact of the crisis and austerity on people, with A special focus on Greece,Ireland, Italy, Portugal and Spain. 2013: 68."},{"key":"2025100520161711000_77.5.305.80","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1093\/eurpub\/cky078","article-title":"Adverse effect of the financial crisis in Greece on perinatal factors","volume":"28","author":"Zografaki","year":"2018","journal-title":"Eur J Public Health"},{"key":"2025100520161711000_77.5.305.81","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60745-5"},{"key":"2025100520161711000_77.5.305.82","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph15102298","article-title":"Economic crisis and amenable mortality in Spain","volume":"15","author":"Nolasco","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"2025100520161711000_77.5.305.83","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(03)00276-4"},{"key":"2025100520161711000_77.5.305.84","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60102-6"},{"key":"2025100520161711000_77.5.305.85","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1002\/hec.3373","article-title":"Health effects of economic crises","volume":"25 Suppl 2","author":"Ruhm","year":"2016","journal-title":"Health Econ"},{"key":"2025100520161711000_77.5.305.86","doi-asserted-by":"publisher","DOI":"10.1162\/003355300554872"},{"key":"2025100520161711000_77.5.305.87","doi-asserted-by":"publisher","DOI":"10.1162\/REST_a_00084"},{"key":"2025100520161711000_77.5.305.88","unstructured":"Cingano F . Trends in income inequality and its impact on economic growth. 2014."},{"key":"2025100520161711000_77.5.305.89","doi-asserted-by":"publisher","DOI":"10.1086\/338781"},{"key":"2025100520161711000_77.5.305.90","unstructured":"Cariolle J . Measuring macroeconomic volatility applications to export revenue data, 1970-2005. 2012: 1970\u20132005."},{"key":"2025100520161711000_77.5.305.91","doi-asserted-by":"crossref","first-page":"13198","DOI":"10.3390\/su132313198","article-title":"The impacts of socioeconomic crisis in Portugal on social protection and social work practices","volume":"13","author":"Casquilho-Martins","year":"2021","journal-title":"Sustainability"},{"key":"2025100520161711000_77.5.305.92","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckx167"},{"key":"2025100520161711000_77.5.305.93","doi-asserted-by":"crossref","DOI":"10.1186\/s40985-017-0059-2","article-title":"Structural adjustment programmes adversely affect vulnerable populations: a systematic-narrative review of their effect on child and maternal health","volume":"38","author":"Thomson","year":"2017","journal-title":"Public Health Rev"},{"key":"2025100520161711000_77.5.305.94","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1177\/1403494816683878","article-title":"Persistence of social inequalities in modern welfare states: explanation of a paradox","volume":"45","author":"Mackenbach","year":"2017","journal-title":"Scand J Public Health"},{"key":"2025100520161711000_77.5.305.95","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.2105\/AJPH.2019.305075","article-title":"Mortality in Spain in the context of the economic crisis and austerity policies","volume":"109","author":"Regidor","year":"2019","journal-title":"Am J Public Health"},{"key":"2025100520161711000_77.5.305.96","doi-asserted-by":"crossref","first-page":"567","DOI":"10.3390\/ijgi9100567","article-title":"Disparities in geographical access to hospitals in Portugal","volume":"9","author":"Costa","year":"2020","journal-title":"IJGI"},{"key":"2025100520161711000_77.5.305.97","unstructured":"Medicins du Monde . Access to health care for vulnerable groups in the EU in 2012: an overview of the condition of persons excluded. 2012."},{"key":"2025100520161711000_77.5.305.98","unstructured":"Strasbourg P , Mui C . Portugal: austerity measures threaten the most vulnerable. 2016: 6\u20137."},{"key":"2025100520161711000_77.5.305.99","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-017-0699-3","article-title":"The effects of neoliberal policies on access to healthcare for people with disabilities","volume":"16","author":"Sakellariou","year":"2017","journal-title":"Int J Equity Health"},{"key":"2025100520161711000_77.5.305.100","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1080\/09581596.2017.1394575","article-title":"Access to health care in an age of austerity: disabled people\u2019s unmet needs in Greece","volume":"29","author":"Rotarou","year":"2019","journal-title":"Critical Public Health"},{"key":"2025100520161711000_77.5.305.101","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jhealeco.2015.02.003","article-title":"Fear itself: the effects of distressing economic news on birth outcomes","volume":"41","author":"Carlson","year":"2015","journal-title":"J Health Econ"},{"key":"2025100520161711000_77.5.305.102","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-14-198","article-title":"Economic downturns and male cesarean deliveries: a time-series test of the economic stress hypothesis","volume":"14","author":"Bruckner","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025100520161711000_77.5.305.103","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.labeco.2016.05.014","article-title":"The effect of job loss on health: evidence from biomarkers","volume":"41","author":"Michaud","year":"2016","journal-title":"Labour Econ"},{"key":"2025100520161711000_77.5.305.104","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.bpobgyn.2015.09.003","article-title":"Perinatal outcomes among migrant mothers in the united kingdom: is it a matter of biology, behaviour, policy, social determinants or access to health care?","volume":"32","author":"Puthussery","year":"2016","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2025100520161711000_77.5.305.105","doi-asserted-by":"crossref","first-page":"2198","DOI":"10.3390\/ijerph10062198","article-title":"Perinatal outcomes of uninsured immigrant, refugee and migrant mothers and newborns living in Toronto, Canada","volume":"10","author":"Wilson-Mitchell","year":"2013","journal-title":"Int J Environ Res Public Health"},{"key":"2025100520161711000_77.5.305.106","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1177\/0020731418822227","article-title":"Financial crisis in portugal: effects in the health care sector","volume":"49","author":"Morais Nunes","year":"2019","journal-title":"Int J Health Serv"},{"key":"2025100520161711000_77.5.305.107","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2019-002122","article-title":"The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in brazil","volume":"5","author":"Andrietta","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2025100520161711000_77.5.305.108","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2013.05.017"},{"key":"2025100520161711000_77.5.305.109","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.healthpol.2017.12.008","article-title":"The impact of the financial crisis and austerity policies on the service quality of public hospitals in Greece","volume":"122","author":"Keramidou","year":"2018","journal-title":"Health Policy"},{"key":"2025100520161711000_77.5.305.110","first-page":"27","article-title":"Ireland\u2019s health care system and the crisis: a case study in the struggle for a capable welfare state","volume":"17","author":"Thomas","year":"2018","journal-title":"An Inst Hig Med Trop (Lisb)"},{"key":"2025100520161711000_77.5.305.111","unstructured":"Economou C , Kaitelidou D . The impact of the financial crisis on the health system and health in Greece. Copenhagen, Denmark, 2014."},{"key":"2025100520161711000_77.5.305.112","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-022-08316-4","article-title":"Hospitals during economic crisis: a systematic review based on resilience system capacities framework","volume":"22","author":"Foroughi","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2025100520161711000_77.5.305.113","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2019-316929"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2022-219639","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T03:16:48Z","timestamp":1759720608000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2022-219639"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,22]]},"references-count":113,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,4,6]]},"published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1136\/jech-2022-219639"],"URL":"https:\/\/doi.org\/10.1136\/jech-2022-219639","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,22]]}}}