Correspondence in this week's Lancet gives a first look at how the financial crisis affected mortality patterns in Europe. The data shows increases in suicide rates between 2007 and 2009 in most countries, but also decreases in road deaths (probably because of higher unemployment leading to less car use). The letter is by Dr David Stuckler, University of Cambridge, UK, Professor Martin McKee, London School of Hygiene and Tropical Medicine, UK, and Dr Sanjay Basu, University of California San Francisco, and colleagues.
Unemployment increased by 2.6 percentage points (a 35% relative increase) between 2007 and 2009 across the EU as a whole. But the authors say: "However, the steady down¬ward trend in suicide rates, seen in both groups of countries [the pre-2004 EU and new EU states joining in 2004] before 2007, reversed at once. The 2008 increase was less than 1% in the new member states, but in the old ones it increased by almost 7%. In both, suicides increased further in 2009. Among the countries studied, only Austria had fewer suicides (down 5%) in 2009 than in 2007. In each of the other countries the increase was at least 5%. These changes are at the upper limit of the estimates in our 2009 paper [published in The Lancet], in which we noted that an increase in unemployment of more than 3% increased suicides in those younger than 65 years."
Road-traffic fatalities also fell sub¬stantially, especially in new member countries where they were initially very high. Three countries had high (Lithuania), medium (Hungary), and low (Nether¬lands) death rates before 2008, indicating that the scale of the post-crisis decline is related to the initial level. Thus, the rate of road-traffic fatalities in Lithuania fell rapidly, by almost 50%. However, when rates are already very low, as in the Netherlands, there is little scope to fall further. Their analysis also concords with data from outside the EU, where for example in the USA road mortality deaths fell by 10%. Availability of organs for transplants, which are dependent on supply from motor-vehicle accidents, have fallen substantially in Spain and Ireland where road-traffic deaths fell by more than 25% between 2007 and 2009.
Variations in availability of data means that those with the most data heavily influence the overall patterns. The UK does so for the pre-2004 EU states while Romania does so for the newer ones. In the UK, suicide rates rose from an a recent low of 6.14 per 100,000 people aged under 65 in 2007 to 6.75 in 2008, an increase of 10%, and remained this high in 2009. UK motor vehicle accident mortality had fluctuated between 2000 and 2007, and then fell by 25% between 2007 and 2009 (from 4.92 per 100,000 population to 3.68). The authors say: "Once data from elsewhere become available, our analysis will need to be updated and the differences in experiences across Europe explored. However, we can already see that the countries facing the most severe financial reversals of fortune, such as Greece and Ireland, had greater rises in suicides (17% and 13%, respectively) than did the other countries, and in Latvia suicides increased by more than 17% between 2007 and 2008."
They refer to their earlier paper, in which they argued that social protection measures such as active labour market policies and strong social support networks could mitigate the predicted increase in suicides. In this context, we note that Austria, with a strong social safety net, had a slight decline in suicides despite an increase in unemployment of 0•6 percentage points between 2007 and 2009. However, unexpectedly, Finland, also with strong social protection systems, had an increase in suicides of just over 5% in the same period, by contrast with previous recessions.
The authors say: "Overall, consistent with our earlier predictions, we found no evidence of a major deviation from past trends in all-cause mortality rates, since the short-term mortality fluctuations were mainly driven by suicides and road-traffic fatalities."
The authors conclude: "These findings...reveal the rapidity of the health consequences of financial crises... We are currently engaged in a much more detailed analysis of the health effects of the ongoing economic crisis and the responses to it, using aggregate mortality and individual-level data from European household surveys, coupled with analyses of policy responses. In particular, we want to understand better why some individuals, communities, and entire societies are especially vulnerable yet some seem more resilient to economic shocks as well as the extent to which the very different policy responses being pursued by European govern¬ments affect health. There is clearly much more to be written on the health consequences of the events of 2008."
Journal
The Lancet