Article Text

Download PDFPDF

Disparities of infant and neonatal mortality trends in Greece during the years of economic crisis by ethnicity, place of residence and human development index: a nationwide population study
  1. Tania Siahanidou1,
  2. Nick Dessypris2,
  3. Antonis Analitis2,
  4. Constantinos Mihas2,
  5. Evangelos Evangelou3,4,
  6. George Chrousos1,
  7. Eleni Petridou2,5
  1. 1 First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
  2. 2 Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
  3. 3 Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
  4. 4 Department of Epidemiology and Biostatistics, Imperial College, London, UK
  5. 5 Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden
  1. Correspondence to Professor Tania Siahanidou; siahan{at}


Objective To study trends of infant mortality rate (IMR) and neonatal mortality rate in Greece during the period 2004–2016 and explore the role of sociodemographic factors in the years of crisis.

Design Nationwide individual data for live births and infant (0–11 months) deaths provided by the Hellenic Statistical Authority were examined using Poisson, joinpoint regression and interrupted time series (ITS) analyses.

Setting Greece.

Participants All infant deaths (n=4862) over the 13-year period, of which 87.2% were born to Greek mothers, and respective live births.

Main outcome measures Evolution of IMR (0–364 days), early (<7 days) neonatal mortality rate (ENMR), late (7–27 days) neonatal mortality rate (LNMR) and post neonatal (28–364 days) mortality rate (PNMR) trends, by maternal nationality, place of residence and Human Development Index (HDI).

Results By Poisson regression, overall, during the study period, among infants of Greek mothers, IMR and PNMR declined significantly (−0.9%; 95% CI −1.7% to −0.1% and −1.6%; −3.0% to −0.2% annually, respectively), although differentially by place of residence (IMRurban: −2.1%; −2.9% to −1.3%, IMRrural: +10.6%; 7.6% to 13.6%). By contrast, among infants of non-Greek mothers, the low starting IMR/ENMR/LNMR/PNMR increased significantly (max ENMR:+12.5%; 8.6% to 16.5%) leading to a non-significant time–trend pattern overall in Greece. The inverse associations of HDI with IMR, ENMR and PNMR were restricted to Greek mothers’ infants. Joinpoint regression analyses among Greek mothers’ infants indicated non-significant increasing trends of IMR and ENMR following the crisis (+9.3%, 2012–2016, p=0.07 and +10.2%, 2011–2016, p=0.06, respectively). By contrast, the high (+17.1%; 8.1% to 26.9%, p=0.002) IMR increases among non-Greek infants were restricted to 2004–2011 and equalised to those of Greek mothers’ infants thereafter. ITS analyses in preset years (2008, 2010, 2012) identified significantly increasing trends in IMR, LNMR and PNMR after 2012, and in ENMR after 2010, among Greek mothers’ infants.

Conclusions HDI and rural residence were significantly associated with IMR. The strongly decreasing IMR trends among Greek-mothers’ infants were stagnated after a lag time of ~4 years of crisis approximating the previously sharply increasing trends among non-Greeks.

  • neonates
  • mortality rates
  • infant deaths
  • perinatal care
  • financial crisis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors EP and GC were involved in the initial conception of the study. All authors contributed to the design, analysis and interpretation of data. TS, ND and EP developed the first draft of the manuscript and all authors critically revised it and approved the final version. ND, AA and CM performed the statistical analyses. EE reviewed statistics and contributed significantly for ITS analyses. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The corresponding author ensures that all the journal’s administrative requirements are properly completed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Data sharing statement Data are available upon request from ELSTAT (

  • Patient consent for publication Not required.