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Evidence suggests that educational differences in perinatal outcomes have increased in some countries (Eastern Europe) while remained stable in others (Scandinavian countries). However, less is known about the experience of Southern Europe. This study aims to evaluate the association between maternal education and perinatal outcomes derived from birthweight (low birthweight and macrosomia) and gestational age (pre-term and post-term births) among Spaniards living in the Autonomous Community of Andalusia during the period 2001-2011 (around 19 % of births in Spain); and to evaluate whether the educational differences narrowed or widened during that period, which includes both an economic boom (2001-2008) and the global economic crisis (2009-2011). This study uses the Andalusian Population Longitudinal Database and the Vital Statistics Data provided by the Spanish National Statistics Institute. We study live and singleton births of Spanish mothers who lived in Andalusia at the time of delivery (n = 404,951). ORs with 95 % confidence intervals (crude and adjusted) were estimated using multinomial regression models. A negative educational gradient is observed in all perinatal outcomes studied (i.e., the higher the educational status, the lower the risk of negative perinatal outcomes). However, when disaggregating the sample in two periods, the gradient is only statistically significant for pre-term birth during 2001-2008, while a full gradient is observed in all perinatal indicators in the period 2009-2011 with an increase in the educational inequalities in macrosomia and post-term. Further studies are needed in order to confirm whether there is a causal association between the widening of the educational differences in perinatal outcomes and the onset of the economic crisis in Spain, or the widening can be explained by other factors, such as changes in childbearing patterns and the composition of women accessing motherhood.

Analyses of health and mortality disparities between today's urban and rural populations appear to be exclusively focused on vastly urbanising countries. By incorporating environmental data at census tract level and accounting for within‐area homogeneity, this work attempts to extend classic rural–urban comparisons. Geographical information is linked to a register‐based mortality follow up and Spanish census data for the autonomous community of Andalusia. We then apply mixed effects Cox proportional hazards models to estimate individual mortality differences and account for area variations between residential areas. Estimated effects suggest that the shared degree of “urbanicity” does not affect individual hazards of mortality, whereas environmental‐ and population‐based measures influence the relative risk of dying despite controlling for individual‐level risk factors. Although we do not find an impact of physical urban measures, our results reveal persistent that area‐related mortality disparities which can help to explain the mechanisms behind prevalent spatial‐temporal inequalities such as those in Andalusia.

Background Previous studies on economic recessions and mortality due to cancer and other chronic diseases have yielded inconsistent findings. We investigated the trend in all-disease mortality and mortality due to several specific diseases before and during the Great Recession of 2008 in individuals who were employed in 2001, at the beginning of follow-up. Methods We follow in a nationwide longitudinal study over 15 million subjects who had a job in Spain in 2001. The analysed outcomes were mortality at ages 25–64 years due to all diseases, cancer and other chronic diseases. We calculated annual mortality rates from 2003 to 2011, and the annual percentage change (APC) in mortality rates during 2003–07 and 2008–11, as well as the effect size, measured by the APC difference between the two periods. Results All-disease mortality increased from 2003 to 2007 in both men and women; then, between 2008 and 2011, all-disease mortality decreased in men and reached a plateau in women. In men, the APC in the all-disease mortality rate was 1.6 in 2003–07 and −1.4 in 2008–11 [effect size −3.0, 95% confidence interval (CI) −3.7 to −2.2]; in women it was 2.5 and −0.3 (effect size −2.8, 95% CI −4.2 to −1.3), respectively. Cancer mortality and mortality due to other chronic diseases revealed similar trends. Conclusions In the group of individuals with a job in 2001 the Great Recession reversed or stabilized the upward trend in all-disease mortality.