title: A "Before and After" in the Use of Emergency Services in Spain? The Impact of the Economic Crisis.
abstract: The objective of this study was to analyse whether variables associated with emergency services (ES) use in Spain have changed in the period 2006-2011 using a comparative analysis of the 2006 and 2011 Spanish National Health Surveys. The measure of association was the prevalence ratio with its 95% confidence interval, obtained by Poisson regression with robust variance. We studied interactions between the explanatory variables for ES use and year and subsequently performed a stratified analysis by year. ES use declined by 2.1% in 2011. Most emergency care (approximately 60% in both surveys) was provided in public hospitals. Between 2006 and 2011, ES use increased by 9% in women (p for interaction = 0.008) [ref. men], 3% in persons with poor mental health (p for interaction = 0.072) [ref. good mental health], and 8% in individuals with limitations on activities of daily living (p for interaction = 0.006) [ref. no limitations]. The change in the effect of the variables sex, mental health, and limitations on activities of daily living on use of ES (2006 and 2011) is not explained by either demographic characteristics or individual socioeconomic indicators. These results could be associated with macroeconomic and structural changes occurring during the period 2006-2011.
authors.affiliation: Department of Preventive Medicine and Public Health, University Hospital Ramón y Cajal, Madrid, Spain plpereira@salud.madrid.org.
authors.forename: Patricia López
authors.initials: PL
authors.lastname: Pereira
authors.affiliation: Department of Preventive Medicine and Public Health, University Hospital Doctor Peset, Valencia, Spain.
authors.forename: Ana Pagá
authors.initials: AP
authors.lastname: Casanova
authors.affiliation: Department of Epidemiology and Biostatistics. National School of Public Health, Institute of Health "Carlos III", Madrid, Spain CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Sanz-Barbero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D057172:Economic Recession; D004632:Emergency Medical Services / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014478:Unemployment; D055815:Young Adult
keywords: Andersen’s model; Spain; economic crisis; emergency services; health services use; health survey