Impact of the global financial crisis on low birth weight in Portugal: a time-trend analysis

Abstract

BackgroundThe 2007–2008 global financial crisis had adverse consequences on population health of affected European countries. Few contemporary studies have studied its effect on perinatal indicators with long-lasting influence on adult health. Therefore, in this study, we investigated the impact of the 2007–2008 global financial crisis on low birth weight (LBW) in Portugal.MethodsData on 2 045 155 singleton births of 1995–2014 were obtained from Statistics Portugal. Joinpoint regression analysis was performed to identify the years in which changes in LBW trends occurred, and to estimate the annual per cent changes (APC). LBW risk by time period expressed as prevalence ratios were computed using the Poisson regression. Contextual changes in sociodemographic and economic factors were provided by their trends.ResultsThe joinpoint analysis identified 3 distinct periods (2 jointpoints) with different APC in LBW, corresponding to 1995–1999 (APC=4.4; 95% CI 3.2 to 5.6), 2000–2006 (APC=0.1; 95% CI −050 to 0.7) and 2007–2014 (APC=1.6; 95% CI 1.2 to 2.0). For non-Portuguese, it was, respectively, 1995–1999 (APC=1.4; 95% CI −3.9 to 7.0%), 2000–2007 (APC=−4.2; 95% CI −6.4 to −2.0) and 2008–2014 (APC=3.1; 95% CI 0.8 to 5.5). Compared with 1995–1999, all specific maternal characteristics had a 10–15% increase in LBW risk in 2000–2006 and a 20–25% increase in 2007–2014, except among migrants, for which LBW risk remained lower than in 1995–1999 but increased after the crisis. The increasing LBW risk coincides with a deceleration in gross domestic product growth rate, reduction in health expenditure, social protection allocation on family/children support and sickness.ConclusionsThe 2007–2008 global financial crisis was associated with a significant increase in LBW, particularly among infants of non-Portuguese mothers. We recommend strengthening social policies aimed at maternity protection for vulnerable mothers and health system maintenance of social equity in perinatal healthcare.

Trends in sociodemographic and health care factors in Portuguese and non‐Portuguese mothers giving birth in Portugal, 1995‐2014

“…Contemporary evidence indicates that as socio‐economic conditions worsen in host country, there is an upsurge in the prevalence of adverse pregnancy outcomes among immigrants . The universal health care and perinatal health system instituted in Portugal for over two decades has contributed in improving pregnancy outcomes irrespective of maternal nativity .…”

“…The rate of adverse pregnancy outcomes could be influenced by period variation in demographic, economic, and social structure of the society or condition of the maternal population including access to health care . In Portugal, the 2007‐2008 global financial crisis was associated with a significant increase in LBW, particularly among infants of non‐Portuguese mothers . It was observed that the financial crisis and austerity measures were associated with household food insecurity, poor health outcomes, and affected health care access .…”

Mortality from Suicide in the Municipalities of Mainland Portugal: Spatio-Temporal Evolution between 1980 and 2015

“…Para identificar alterações na tendência (joinpoint) 42 da taxa de suicídio e estimar a variação relativa média anual em cada um dos períodos identificados no arco temporal de 1980 a 2015 foi aplicado um modelo de regressão log-linear. A análise começa com o número mínimo de joinpoints e testa se a inclusão de novos joinpoints é estatisticamente significativa.…”

“…Os autores declaram que os procedimentos seguidos estavam de acordo com os regulamentos estabelecidos pelos responsáveis da Comissão de Investigação Clínica [38][39][40][41][42][43][44] e Ética e de acordo com a Declaração de Helsínquia da Associação Médica Mundial.…”

“…Desde então, tem sido amplamente estudada por diversos autores a influência do contexto no risco de morrer por suicídio: pobreza, 4,5 privação socioeconómica, [6][7][8][9] baixo rendimento, [10][11][12] desemprego, 10,13,14 mau acesso a equipamentos Loureiro A, et al Mortalidade por suicídio em Portugal continental entre 1980 e 2015, Acta Med Port 2018 Jan;31(1): [38][39][40][41][42][43][44] e serviços, 15,16 baixa utilização de espaços verdes, 17 ruralidade [18][19][20] e baixa densidade. 8,21,22 Para além do exposto, em contextos de crise, os efeitos tendem a agravar-se, aumentando as situações de vulnerabilidade e desigualdade, e, consequentemente, o risco e a mortalidade por suicídio.…”