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Impact of the great recession on self-perceived health in Spain: a longitudinal study with individual data
  1. Marc Saez1,2,3,
  2. Joaquim Vidiella-Martin4,5,
  3. Guillem López Casasnovas3,6,7
  1. 1 Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
  2. 2 CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
  3. 3 Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
  4. 4 Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
  5. 5 Tinbergen Institute, Amsterdam, The Netherlands
  6. 6 Department of Economics and Business, Department of Economics and Business, Barcelona, Spain
  7. 7 Barcelona Graduate School (BGSE), Universitat Pompeu Fabra, Barcelona, Spain
  1. Correspondence to Dr Marc Saez; marc.saez{at}


Objectives Our objective in this study is to evaluate the impact the Great Recession (2008–2014) had on self-perceived health in Spain.

Design We use a longitudinal database (four waves of the Bank of Spain’s Survey of Household Finances (2005, 2008, 2011 and 2014)) with repeated observations of the same individuals before and after the Great Recession.

Interventions We consider the Great Recession in a natural experiment and we introduce it as an explanatory variable in a mixed logistic regression model in which we explain the probability of a subject declaring poor health (fair, bad and very bad). In the model we control for both observed and unobserved confounders at both individual and family level.

Results We find an average downward trend in self-perceived health during the most severe period of the Great Recession (2009–2011). However, the fact that the adjusted measures are less volatile than the crude ones shows that variation in health status can be captured by either demographic or socioeconomic controls. In fact, there are significant differences in the impact the economic crisis had on health in terms of gender and age group. In particular, the (adjusted) risk of declaring poor health increases after the crisis began but only in those families in which the reference person is a woman younger than 45 years of age or a man aged 75 years or older.

Conclusions Given our results, we discuss the link between financial wealth and self-rated health and how policy-makers could address the health inequalities that arise from adverse economic and financial shocks.

  • health
  • great recession
  • spain
  • inequality

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  • Contributors GLC and MS had the original idea for the paper. MS designed the study. The bibliographic search and the writing of the introduction were carried out by JV-M and MS. The methods and statistical analysis were chosen and performed by MS. JV-M created the tables and figures. All authors wrote the results and the discussion. The writing and final editing was done by MS, JV-M and GL-C. All authors reviewed and approved the manuscript.

  • Funding This work was partly funded by the University of Girona (MPCUdG2016 and GDRCompetUdG2017) and by an unrestricted grant from Obra Social ‘La Caixa’.

  • Competing interests The manuscript is an original contribution that has not been published before, whole or in part, in any format, including electronically. All authors will disclose any actual or potential conflict of interest including any financial, personal or other relationships with other people or organisations that could inappropriately influence or be perceived to influence their work, within three years of beginning the submitted work.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We used Survey of Household Finances (EFF in Spanish) from the Bank of Spain. Public and freely accessible at: