title: Medium-term impact of the economic crisis on mortality, health-related behaviours and access to healthcare in Greece.
abstract: Previous studies on the health consequences of the crisis in Greece investigated short-term impacts on selected outcomes. This study examined the impact of the crisis on a key set of health indicators with longer follow up than previous studies. We conducted interrupted time series (ITS) analysis to compare trends in standardised mortality by cause before and during the crisis. We examined changes in fruit and vegetable consumption, smoking, physical activity, obesity, out-of-pocket payments and unmet needs for healthcare using national household data from the "Hellas Health" surveys. Standardised mortality rates for suicides (p < 0.001) and infant mortality (p = 0.003) increased during the crisis compared to pre-existing trends, while mortality from respiratory diseases (p = 0.053) and transport accidents (p = 0.067) decreased. The prevalence of smoking (42.6% to 36.5%; RR = 0.86) and sedentary lifestyle (43.4% to 29.0%; RR = 0.69) declined. The prevalence of unmet need for healthcare significantly increased from 10.0% to 21.9% (RR = 2.10) and the proportion of people paying out-of-pocket for healthcare from 34.4% to 58.7% (RR = 1.69) between 2010 and 2015. The impact of the economic crisis in Greece on health was more nuanced than previous reports suggest. Effective strategies to mitigate the adverse health impacts of economic crises need to be better understood and implemented.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom.|Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Filippos T
authors.initials: FT
authors.lastname: Filippidis
authors.affiliation: Department of Respiratory Medicine, Harefield Hospital, Royal Brompton &Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Gerovasili
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
authors.affiliation: Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Yannis
authors.initials: Y
authors.lastname: Tountas
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D004032:Diet; D057172:Economic Recession; D005260:Female; D006115:Greece / Q000453:epidemiology; D015438:Health Behavior; D006297:Health Services Accessibility / Q000191:economics*; D006306:Health Surveys; D006801:Humans; D008297:Male; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology; D013405:Suicide; D015996:Survival Rate