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Excess winter mortality and morbidity before, during, and after the Great Recession: the Portuguese case

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Abstract

Although winter mortality and morbidity are phenomena common to most European countries, their magnitude varies significantly from country to country. The geographical disparities among regions with similar climates are the result of several social, economic, demographic, and biological conditions that influence an individual’s vulnerability to winter conditions. The impact of poor socioeconomic conditions may be of such magnitude that an economic recession may aggravate the seasonal mortality pattern. This paper aims to measure the seasonal winter mortality, morbidity, and their related costs during the Great Recession (2009–2012) in mainland Portugal and its Regional Health Administrations (RHAs) and to compare it with the periods preceding and following it. Monthly mortality and morbidity data were collected and clustered into three periods: Great Recession (2009–2012), Pre-Recession (2005–2008), and Post-Recession (2013–2016). The impact of seasonal winter mortality and morbidity during the Great Recession in Portugal and its Regional Health Administrations was measured through the assessment of age-standardized excess winter (EW) death and hospital admissions rate and index, expected life expectancy gains without EW deaths, EW rate of potential years of life lost, and EW rate of emergency hospital admission costs. Important increases of winter deaths and hospital admissions were identified, resulting in an important number of potential years of life lost (87 years of life lost per 100,000 inhabitants in 2009–2012), life expectancy loss (1 year in 2009–2012), and National Health Service costs with explicit temporal and spatial variations. These human and economic costs have decreased consistently during the analyzed periods, while no significant increase was found during the Great Recession. Despite its reduction, the winter excess morbidity and mortality highlight that Portugal still faces substantial challenges related to a highly vulnerable population, calling for investments in better social and health protection.

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Abbreviations

RHA:

Regional Health Administrations

EW:

Excess winter

NHS:

National Health Service

LVT:

Lisboa e Vale do Tejo

PYLL:

Potential years of life lost

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Funding

RA and PS are part of CEGOT, Research Centre in Geography and Spatial Planning, that is supported by the European Regional Development Funds, through the COMPETE 2020 – Operational Programme “Competitiveness and Internationalization,” under Grant POCI-01-0145-FEDER-006891; and by National Funds through the Portuguese Foundation for Science and Technology (FCT) under Grant UID/GEO/04084/2013. RA was funded by FCT doctoral fellowship SFRH/BD/92568/2013 and by the CEGOT group Cities, competitiveness, and well-being (UID/GEO/04084/2013) through COMPETE 2020.

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Authors and Affiliations

  1. Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal

    Ricardo Almendra

  2. Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal

    Julian Perelman

  3. Polytechnic Institute of Leiria, IGOT/CEG Universidade de Lisboa, Lisbon, Portugal

    Joao Vasconcelos

  4. Centre of Studies on Geography and Spatial Planning, Department of Geography, University of Coimbra, Coimbra, Portugal

    Paula Santana

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  1. Ricardo Almendra
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  2. Julian Perelman
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  3. Joao Vasconcelos
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  4. Paula Santana
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Contributions

RA, PS, JP, and JV contributed to the study conception and design. RA was responsible for the acquisition of data. RA, PS, JP, and JV contributed to the analysis and interpretation of data. RA was responsible for drafting of manuscript. RA, PS, JP, and JV contributed to the critical revision and final version of the manuscript.

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Correspondence to Ricardo Almendra.

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Almendra, R., Perelman, J., Vasconcelos, J. et al. Excess winter mortality and morbidity before, during, and after the Great Recession: the Portuguese case. Int J Biometeorol 63, 873–883 (2019). https://doi.org/10.1007/s00484-019-01700-6

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  • DOI: https://doi.org/10.1007/s00484-019-01700-6

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