O iginal Resea ch
Recession, employmen and sel - a ed heal h:
a s udy on he gende gap
Q3 I. Aguila -Palacio
a,b,c,*
,P. Ca e a-Las uen es
d
,R. S!
anchez-Recio
b,e
,
J.P. Alonso
a,b
,M.J. Rabanaque
a,b,c
a
Mic obiology, P e en i e Medicine and Public Heal h Depa men , Za agoza Uni e si y, Domingo Mi al S/n, 50009,
Za agoza, Spain
b
G oup o Heal h Se ices Resea ch o A agon, (GRISSA), Spain
c
IIS A agon, Spain
d
CIBER Hepa ic and Diges i e Diseases, Spain
e
Gende Violence Depa men , Go e nmen Rep esen a ion Depa men , San Juan 4, 44001, Te uel, Spain
a icle in o
A icle his o y:
Recei ed 4 May 2017
Recei ed in e ised o m
5 Oc obe 2017
Accep ed 19 Oc obe 2017
A ailable online xxx
Keywo ds:
Gende inequali ies
Sel - a ed heal h
Employmen
Recession
abs ac
Objec i es: Employmen s a us and economic ecession ha e been associa ed wi h nega i e
e ec s on sel - a ed heal h, and his e ec di e s by gende . We analysed he e ec s o he
Spanish economic ecession in e ms o sel - a ed heal h, i s di e en ial e ec among
gende s and i s in luence on gende gap.
S udy design: Repea ed c oss-sec ional s udy using Spanish heal h su eys (2001e2014).
Me hods: Logis ic eg ession models we e conduc ed o explo e he associa ion be ween
sel - a ed heal h and employmen s a us and i s e olu ion o e ime and gende . To es
he impac o he economic ecession, pooled da a eg ession models we e conduc ed.
Resul s: In his s udy, we conside ed 104,577 subjec s. Du ing he las 15 yea s, women ha e
en e ed he labou ma ke , leading o wide changes in he Spanish adi ional amily oles.
Ins ead o an inc easing p opo ion o women wo ke s, gende employmen di e ences
pe sis . The e o e, in 2014, he p e alence o wo ke s was 55.77% in men, whe eas in
women, i was 44.01%. Sel - a ed heal h ends du ing he economic ecession di e by
gende , wi h women imp o ing sligh ly hei sel - a ed heal h om a low sel - a ed heal h
p e alence o 38.76% in 2001 o 33.78% in 2014. On he con a y, men seem mo e ulne able
o employmen ci cums ances, which ha e led o subs an ial educ ion in he gende gap.
Conclusions: Al hough a gende gap pe sis s, he change in socio-economic oles seems o
inc ease women sel - a ed heal h, educing his gap. I is impo an o p omo e women
labou ma ke inclusion, e en in economic ecession pe iods.
©2017 The Royal Socie y o Public Heal h. Published by Else ie L d. All igh s ese ed.
*Co esponding au ho . Medicine Facul y, Mic obiology, P e en i e Medicine and Public Heal h Depa men , C/Domingo Mi al s/n,
50009, Za agoza, Spain. Tel.: þ34 976761761; ax: þ34 976761762.
E-mail add ess: [email p o ec ed] (I. Aguila -Palacio).
A ailable online a www.sciencedi ec .com
Public Heal h
jou nal homepage: www.else ie .com/puhe
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public heal h xxx (2017) 1e6
PUHE3054_p oo ■17 No embe 2017 ■1/6
h ps://doi.o g/10.1016/j.puhe.2017.10.013
0033-3506/©2017 The Royal Socie y o Public Heal h. Published by Else ie L d. All igh s ese ed.
Please ci e his a icle in p ess as: Aguila -Palacio I, e al., Recession, employmen and sel - a ed heal h: a s udy on he gende gap,
Public Heal h (2017), h ps://doi.o g/10.1016/j.puhe.2017.10.013
In oduc ion
F om 1995 o 2007, Spain had one o he as es g owing g oss
domes ic p oduc s (GDPs) in he Eu opean Union (EU).
1
Du ing
his pe iod, women en e ed he labou ma ke , bu he emale
unemploymen a e in Spain con inued o be one o he
highes in he EU. The global ecession o 2007 b oke his
end, leading o a d as ic inc ease in unemploymen , espe-
cially among young people
2
and o inc easing job insecu i y.
3
This si ua ion, ha has been conside ed a po en ial h ea o
public heal h,
4
has shown con o e sial esul s in Spain.
5e7
Many esea che s ha e d awn a en ion o he nega i e
e ec s o unemploymen on sel - a ed heal h.
8
Heal h- ela ed
mechanisms a e linked o he ma e ial consequences and
psychosocial e ec s o employmen s a us.
9
His o ically, he
impac o ecession and unemploymen on heal h has been
highe on men,
10
bu some au ho s ha e poin ed ou i s e ec
on women's heal h.
11
Women's impo ance as b eadwinne s
inc eases du ing ecession pe iods, when unemploymen
a es a e highe in men han in women.
12
This change in
gende oles, wi h women ceasing o be only ‘unpaid house-
hold labou ’and en e ing he labou ma ke , has been
conside ed as one o he main easons o sel - a ed heal h
imp o emen in women.
12e14
None heless, a common p ob-
lem when analysing he impac o women's employmen
s a us on heal h is ha ‘unpaid household labou ’is usually
assigned o he spouse's occupa ion, which may misclassi y
cu en social ci cums ances.
9
This di e en ial classi ica ion
gains special ele ance in he Spanish con ex , whe e adi-
ional a i udes ela ed o social gende oles pe sis .
15,16
The e o e, i is impo an o de e mine whe he unem-
ploymen , in a ecession con ex , in luences gende s di e -
en ly, and how his a ec s he adi ional gende gap. To
ackle his ques ion, he aim o his a icle was o s udy he
di e ences in sel - a ed heal h and he ole o employmen
s a us on hese di e ences by gende o he pe iod
2001e2014.
Me hods
Design and s udy popula ion
We conduc ed epea ed c oss-sec ional analyses using da a
om Spanish heal h su eys. Da abases used we e he
Spanish Na ional Heal h Su eys (NHS) de eloped in 2001,
2003, 2006, 2011e12, and he 2009 and 2014 Eu opean Heal h
In e iew Su ey o Spain (EHIS). The NHS and EHIS a e na-
ionally ep esen a i e, c oss-sec ional su eys o he esiden
popula ion aged mo e han 15 yea s. Bo h su eys ha e a
simila s uc u e and eco d compa able da a. The economic
c isis o 2007 spli s his pe iod in o wo, wi h h ee su eys
be o e and ano he h ee a e he c isis onse .
The NHS has been implemen ed by he Spanish Heal h
Minis y since 1987. The EHIS was p oposed by he Eu opean
Commission o EU Membe S a es and implemen ed by he
Spanish Na ional S a is ics Ins i u e (INE). The 2009 EHIS was
he i s su ey unde aken in Spain, and i was epea ed in
2014, al e na ing wi h he NHS. The Heal h Minis y and he
INE wo k oge he o s o e he main da a se ies and o
gua an ee da a compa ison. In all cases, da a was ob ained
using conglome a ed poly ypic sampling, and in o ma ion
was collec ed by pe sonal in e iew. Sample sizes a ied
om 29,478 in 2006 NHS o 21,007 in 2011e12. Mo e de ails o
su ey me hodologies can be ound elsewhe e.
17,18
The s udy
popula ion was es ic ed o pa icipan s aged 25 yea s o
mo e.
Va iables included in he analysis
In o de o de e mine he employmen s a us, he ques ion
‘Acco ding o you p esen economic ac i i y, wha is you
employmen si ua ion?’was used. Responses we e codi ied
in o ou ca ego ies: wo king, unemployed, pensione s and
‘unpaid household labou ’. Indi iduals ha belonged o o he
ca ego ies o we e non- esponde s we e classi ied as
‘missing’. ‘Unpaid household labou ’
14
e e o people who
only decla e o be homemake s. The e a e people, especially
women, who belong o o he ca ego ies bu a he same ime
a e ‘unpaid household labou ’. Heal h su eys do no make
his dis inc ion.
P e alence o low sel - a ed heal h was ob ained om he
ques ion ‘How would you a e you heal h in he las 12
mon hs?’sco ed on a 5-poin scale. I was eg ouped in o 2
ca ego ies: low sel - a ed heal h, when he answe was
‘mode a e’, ‘poo ’o ‘ e y poo ’and good sel - a ed heal h, i
he answe was ‘good’o ‘ e y good’.
19
S a is ical analysis
S a is ical analysis comp ised h ee phases. In he i s phase,
da a o each su ey we e analysed sepa a ely. The es ima ed
p e alence o low sel - a ed heal h in men and women we e
calcula ed o each su ey, as well as he e olu ion o
employmen s a us by sex. In o de o asce ain he gende
e ec , di e ences by men and women we e calcula ed. To
gua an ee da a compa abili y, analyses we e s anda dised by
age, aking he Spanish age dis ibu ion in 2001 ( i s yea
analysed) as e e ence. S anda dised p e alences wi h hei
95% con idence in e als (95% CIs) we e ob ained. When
app op ia e, analyses o end we e applied.
In he second phase, logis ic eg ession models o each
su ey we e used o explo e he associa ion be ween sel -
a ed heal h and employmen s a us and i s e olu ion. Ana-
lyses we e s a i ied by men and women and adjus ed by age.
Odds a ios (ORs) and hei 95% CIs we e ob ained. The p e-
dic i e capaci y o employmen o sel - a ed heal h was
checked by he C s a is ic, de ined as he a ea below he ROC
cu e (AUC). I can ake alues be ween 0.5 and 1, whe e 1
indica es pe ec p edic ion, 0.5 implies low disc imina i e
capaci y.
20
In he hi d phase, o es he impac o ecession, su eys
we e combined and a pooled da a se was c ea ed. 2009 EHIS
was chosen as he e e ence g oup, as his was he i s su ey
conduc ed a e and du ing he cu en economic c isis in
Spain. Odds a ios and hei 95% CI o low sel - a ed heal h by
yea o analysis compa ed o 2009 we e compu ed. Di e en
models we e de eloped adjus ing by po en ial con ounde s.
Bo h models we e s a i ied by men and women.
public heal h xxx (2017) 1e62
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PUHE3054_p oo ■17 No embe 2017 ■2/6
Please ci e his a icle in p ess as: Aguila -Palacio I, e al., Recession, employmen and sel - a ed heal h: a s udy on he gende gap,
Public Heal h (2017), h ps://doi.o g/10.1016/j.puhe.2017.10.013
Weigh s a ailable we e used o a oid mis akes associa ed
wi h su ey design o indi idual non- esponses wi hin
households. Analyses we e ca ied ou using IBM SPSS S a-
is ics 22
®
and S a a 12
®
(Za agoza Uni e si y licence).
Resul s
104,577 Spanish adul s we e included in he s udy. Table 1
shows he e olu ion o sel - a ed heal h and employmen
s a us om 2001 o 2014 in Spain. In men, wo ke s we e he
mos equen g oup and dec eased by 5% du ing he pe iod.
A he same ime, unemployed inc eased by mo e han 10%,
and pensione s dec eased by 5%. All hese di e ences we e
s a is ically signi ican be ween he i s and las yea o he
pe iod. Men ‘unpaid household labou s’ca ego y was e y
small and al hough displayed, does no o e ele an da a.
In women, he main ca ego y in 2001 was ‘unpaid house-
hold labou ’(40.69%). By 2014, hey ha e dec eased by 23%, o
less han hal be o e. In 2014, he main ca ego y o women
was wo ke s, which inc eased by 12% compa ed o 2001.
Finally, in his pe iod, women pensione s inc eased by 2% and
unemployed by 9%. All hese di e ences we e s a is ically
signi ican be ween he i s and las yea o he pe iod.
In Fig. 1AeC, di e ences in employmen , unemploymen
and pensione s'p e alence be ween men and women can be
obse ed o he pe iod 2001e2014. Di e ences in wo ke s'
p e alence by gende (Fig. 1A) dec eased signi ican ly (slope
o end ¼#0.014; P<0.0001). The e we e also signi ican
di e ences in unemploymen s a us (Fig. 1B), (slope o
end ¼#0.0003; P¼0.015). Finally (Fig. 1C), di e ences in
pensione s dec eased signi ican ly (slope o end ¼#0.0054;
P<0.0001). We do no show di e ences in ‘unpaid household
labou ’s a us because he p e alence in men is e y small,
and i shows he e olu ion o women only, as al eady showed.
In he pe iod conside ed, low sel - a ed heal h was
signi ican ly highe in women han men (Table 1). In men,
he e we e ew changes in his s a us. Women's low sel -
a ed heal h p e alence dec eased signi ican ly om 2001 o
2014.
Fig. 1D shows p e alence di e ences in sel - a ed heal h in
men wi h espec o women and hei end. Di e ences by
gende dec eased signi ican ly o e ime (slope o end
#0.0020, P<0.0001), obse ing he lowes di e ence be ween
men and women in 2014.
In Table 2, he associa ion be ween sel - a ed heal h and
employmen s a us was conside ed, adjus ed by age. Wo ke s
we e chosen as he e e ence ca ego y because hey showed
he highes le el o sel - a ed heal h. Belonging o any o he
employmen s a us was signi ican ly associa ed wi h wo se
sel - a ed heal h le els, o bo h men and women and all he
yea s conside ed, excep o men ‘unpaid household labou ’.C
s a is ic showed a ai explana o y capaci y o employmen
s a us on sel - a ed heal h.
In Table 3, isk o low sel - a ed heal h by yea o analysis
compa ed o 2009 is conside ed in h ee models, adjus ed by
di e en a iables. Fo bo h men and women, he e was a
signi ican ly highe isk o low sel - a ed heal h be o e he
2007 c isis. The h ee models sugges be e sel - a ed heal h
a e he 2007 c isis in men and women, bu his associa ion
was no signi ican a e adjus ing by socio-economic and
medical a iables.
Discussion
Acco ding o ou esul s, he e has been a p o ound change in
Spain's gende oles om 2001 o 2014. This change, which has
a ec ed mainly women in a e y as pace, is unp eceden ed
in Spain, and may ha e impo an consequences. A consid-
e able p opo ion o women ha e le hei adi ional ole as
‘unpaid household labou ’ o join he labou ma ke . The
impac o he 2007 economic c isis has inc eased he p e a-
lence o unemploymen , bo h in men and women. Al hough
he e a e s ill di e ences be ween men and women wo ke s'
p e alence, wo king women has ema kably inc eased. Sel -
Table 1 eP e alence o di e en employmen s a us and low sel - a ed heal h in Spain be o e and a e he 2007 economic
c isis (2001e2014).
Wo ke s Unemployed Pensione s Unpaid household labou Low sel - a ed heal h
% 95% CI % 95% CI % 95% CI % 95% CI % 95% CI
Male 2001 61.09 59.45e62.74 5.76 5.25e6.26 31.83 30.59e33.08 0.13 0.05e0.21 28.33 27.18e29.48
2003 62.83 61.25e64.40 5.92 5.44e6.41 28.84 27.69e29.98 0.55 0.39e0.71 30.83 29.69e31.98
2006 63.54 62.19e64.88 6.10 5.68e6.52 29.61 28.64e30.59 0.12 0.06e0.18 31.13 30.16e32.10
2009 58.58 57.08e60.08 13.71 12.98e14.44 25.99 24.91e27.07 0.49 0.34e0.64 27.76 26.70e28.82
2012 54.58 53.09e56.08 16.67 15.84e17.50 27.10 25.99e28.21 0.75 0.57e0.93 26.43 25.37e27.48
2014 55.77 54.31e57.24 16.11 15.32e16.91 26.08 25.07e27.09 0.30 0.19e0.40 27.19 26.18e28.20
Female owhead 2001 32.32 31.45e33.19 7.52 6.98e8.05 18.41 17.80e19.01 40.69 39.72e41.67 38.76 37.84e39.69
2003 39.67 38.82e40.52 7.71 7.19e8.23 16.14 15.56e16.71 34.09 33.20e34.98 39.33 38.45e40.22
2006 43.65 42.94e44.36 7.88 7.43e8.33 19.24 18.76e19.73 28.34 27.61e29.07 41.48 40.71e42.25
2009 45.18 44.33e46.03 12.32 11.69e12.96 17.84 17.30e18.37 23.66 22.86e24.45 34.67 33.86e35.49
2012 44.59 43.72e45.46 13.21 12.54e13.88 17.58 17.01e18.15 23.36 22.57e24.16 33.88 33.01e34.75
2014 44.01 43.17e44.86 16.44 15.74e17.14 20.20 19.68e20.72 18.03 17.33e18.73 33.78 33.00e34.61
Resul s a e s anda dised by age and s a i ied by gende .
95% CI: 95% con idence in e al.
public heal h xxx (2017) 1e63
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PUHE3054_p oo ■17 No embe 2017 ■3/6
Please ci e his a icle in p ess as: Aguila -Palacio I, e al., Recession, employmen and sel - a ed heal h: a s udy on he gende gap,
Public Heal h (2017), h ps://doi.o g/10.1016/j.puhe.2017.10.013
a ed heal h is wo se in unemployed, pensione s and ‘unpaid
household labou ’ han wo ke s. Finally, sel - a ed heal h has
imp o ed o women, al hough con inues o be wo se han
men.
Women's employmen a es ha e inc eased in mos
Wes e n economies in he las decade. In Spain, he a es o
gende gap emain signi ican ly lowe han ha in o he EU
coun ies ho izon ally (women and men wo k in di e en
economic's sec o s) and e ically (lowe women's p og ess up
he ca ee ladde ).
21
Wi h he economic c isis, coun ies ha
expe ienced asse bubbles inc eased unemploymen a es,
especially in blue-colla wo ke s. On he con a y, he se ice
sec o , whe e women mainly wo k, has had he lowes
losses.
22,23
The impo ance o women as b eadwinne s in a ecession
con ex is widely known. Du ing he G ea Ame ican Reces-
sion, employmen loss was lowe in women han in men, and
women ound a job ea lie .
24
In p e ious ecessions, he
change in amily oles was also desc ibed, and women
became, in many cases, he main ea ne .
25
Women aban-
doned p og essi ely being ‘unpaid household labou ’, which
has ne e been conside ed as an economic ac i i y and joined
he p o essional wo ld.
26,27
Mo eo e , gende di e ence in he
pu sui o highe educa ion sugges s ha his end will
con inue in he u u e.
25
This ac has also been obse ed in
ou s udy, wi h a signi ican inc ease in women employmen
a es and a p og essi e dec ease in he numbe o ‘unpaid
household labou ’. Also, women ma ke inse ion has
Fig. 1 eDi e ences in p e alence (%) o employmen s a us (AeC) and low sel - a ed heal h (D) be ween males and emales.
95% con idence in e als and hei end. Resul s s anda dised by age (Spain, 2001e2014).
Table 2 eOdds a ios (OR) and hei 95% con idence in e als (95% CI) o low sel - a ed heal h o di e en employmen
s a us compa ed o wo ke s, and C s a is ic alue o he model (Spain, 2001e2014).
Wo ke s Unemployed
OR (95% CI)
Pensione s
OR (95% CI)
Unpaid household labou
OR (95% CI)
C s a is ic
Male 2001 1 2.02 (1.64e2.50)* 3.29 (2.79e3.86)* 1.86 (0.50e6.83) 0.727
2003 1 2.51 (2.07e3.04)* 2.65 (2.26e3.12)* 1.03 (1.02e1.03)* 0.726
2006 1 1.55 (1.29e1.87)* 2.13 (1.83e2.47)* 0.88 (0.22e3.51) 0.710
2009 1 1.79 (1.53e2.09)* 1.71 (1.43e2.06)* 1.05 (1.04e1.05)* 0.746
2012 1 1.62 (1.40e1.88)* 1.64 (1.37e1.97)* 1.79 (1.03e3.14)* 0.723
2014 1 2.16 (1.89e2.48)* 1.94 (1.63e2.31)* 3.30 (1.53e5.19)* 0.721
Female 2001 1 1.73 (1.43e2.09)* 1.63 (1.37e1.93)* 1.45 (1.28e1.63)* 0.720
2003 1 1.40 (1.18e1.67)* 2.35 (2.01e2.76)* 1.58 (1.42e1.76)* 0.725
2006 1 1.68 (1.47e1.91)* 1.75 (1.54e1.99)* 1.40 (1.28e1.53)* 0.710
2009 1 1.63 (1.41e1.89)* 1.57 (1.33e1.85)* 1.47 (1.30e1.66)* 0.753
2012 1 1.85 (1.61e2.13)* 1.88 (1.60e2.21)* 1.69 (1.49e1.91)* 0.741
2014 1 2.04 (1.80e2.32)* 1.62 (1.39e1.90)* 1.86 (1.64e2.11)* 0.738
Logis ic Reg ession adjus ed by age and s a i ied by gende .
OR: Odds Ra ios; 95% CI: 95% Con idence In e als.
*Resul s a e s a is ically signi ican .
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PUHE3054_p oo ■17 No embe 2017 ■4/6
Please ci e his a icle in p ess as: Aguila -Palacio I, e al., Recession, employmen and sel - a ed heal h: a s udy on he gende gap,
Public Heal h (2017), h ps://doi.o g/10.1016/j.puhe.2017.10.013
inc eased amily wo kload because women keep doing he
mos housewo k.
28
This si ua ion has been called as ‘double
wo kload ’.
15,29
Many au ho s ha e desc ibed a p o ec i e e ec o
employmen on sel - a ed heal h.
30,31
In Spain, con adic o y
esul s ha e been obse ed. A oyo e al.
32
concluded ha he
p obabili y o epo ing poo heal h in 2006 was no signi i-
can ly di e en han in 2011. U banos-Ga ido and L!
opez-
Valc!
a cel
33
did no ind s a is ically signi ican di e ences in
he pe cen age o sel -decla ed poo heal h a e he c isis o
he o al popula ion. In con as , Regido e al.
5
ound a
downwa d end du ing ecession, bu in his case, he
me hodology was di e en om he es . In Eu ope, a s udy
conside ing he indi idual-le el changes in sel - a ed heal h
be o e and du ing he economic c isis ound ha he wo king-
age popula ion in Eu opean coun ies expe ienced an
inc easing end in ai and poo sel -heal h a ed, ega dless
he se e i y o ecessions. These esul s we e obse ed in all
coun ies excep in Spain, whe e a declining end was
obse ed,
34
as i has been ound in ou s udy.
We ha e obse ed how di e ences be ween low sel - a ed
heal h and gende dec eased in he pe iod s udied, educing
he gende gap. Bamb a a i ms
35
ha men a e his o ically
mo e ulne able du ing economic down u ns. Abebe e al.
34
ound ha women ended o be mo e a ec ed han men
be o e he c isis as well as among he se e e ecession coun-
ies. The g owing pa icipa ion o women in he labou
ma ke could also explain hese esul s.
36,37
The e a e some implica ions o policy ha could be
ex ac ed om hese esul s. The lack o gende sensi i eness
in in o ma ion sys ems hampe s gende esea ch. In his
sense, some ques ions should be added o heal h su eys, as
in o ma ion ela ed o he numbe o wo king hou s o he
exis ence o ‘double wo kload’. This could acili a e he
in e p e a ion o he ela ionship be ween employmen and
women wellness. As ou s udy shows, he inclusion o women
in labou ma ke has posi i e e ec s on women's heal h e en
in ecession pe iods. A special e o should be made o
p omo e women labou ma ke inse ion. Finally, policies o
imp o e wo k econcilia ion and amily li e a e always
necessa y bu a e essen ial in ecession pe iods, when women
become he main ea ne . I is essen ial o be awa e o he need
o co- esponsibili y in household ac i i ies, o manage
adequa ely he changing ole in oday's wo ld.
This is he i s s udy conduc ed in Spain du ing he eco-
nomic ecession whe e he changing ole o employmen in
women has been obse ed, as well as he educ ion on gende
gap. None heless, his s udy has some limi a ions. Na ional
Heal h Su eys a e c oss-sec ional s udies epea ed in ime:
al hough hey gi e a measu e o ime end, hey do no p o-
ide a pe son- ime ame. The e we e e y low numbe s o
male ‘unpaid household labou ’; he e o e, hese esul s mus
be conside ed cau iously. O he a iables, such as income,
could no be analysed because o he high numbe o missing
alues. On he o he hand, su eys we e ep esen a i e a a
na ional le el, and di ec s anda disa ion allowed compa i-
sons h ough ime. Va iables included in he analysis we e
collec ed and codi ied in he same way h oughou he pe iod,
and he missing da a did no exceed 1% in any o he su eys
o he a iables used.
In Spain in 2014, women con inue o ha e lowe employ-
men a es and wo se sel - a ed heal h han men. Howe e ,
he e is a posi i e e olu ion in he yea s s udied, wi h an
economic ecession a he middle o he pe iod. The change in
socio-economic oles wi h p og essi e inco po a ion o he
labou ma ke has led o mo e women becoming main
ea ne s. This seems o inc ease hei well-being as measu ed
by sel - a ed heal h.
Au ho s a emen s
E hical app o al
E hical app o al was no equi ed due o he public and
anonymous cha ac e is ics o mic o-da a.
Table 3 eLow sel - a ed heal h isk by yea o analysis compa ed o 2009 (Spain, 2001e2014).
Model 1
OR (95% CI)
Model 2
OR (95% CI)
Model 3
OR (95% CI)
Male 2001 1.05 (0.98e1.12) 1.15 (1.07e1.24)* 1.28 (1.19e1.38)*
2003 1.20 (1.12e1.29)* 1.35 (1.26e1.45)* 1.44 (1.34e1.55)*
2006 1.23 (1.15e1.32)* 1.37 (1.28e1.47)* 1.34 (1.25e1.44)*
2009 1 1 1
2012 0.92 (0.86e0.99)* 0.93 (0.87e1.01) 1.01 (0.98e1.13)
2014 0.97 (0.90e1.04) 0.97 (0.91e1.04) 1.05 (0.98e1.13)
Female 2001 1.18 (1.11e1.25)* 1.17 (1.10e1.25)* 1.27 (1.19e1.35)*
2003 1.22 (1.14e1.28)* 1.26 (1.18e1.33)* 1.32 (1.24e1.41)*
2006 1.34 (1.27e1.41)* 1.40 (1.33e1.48)* 1.37 (1.29e1.45)*
2009 1 1 1
2012 0.91 (0.86e0.96)* 0.94 (0.88e1.00) 1.05 (0.99e1.12)
2014 0.89 (0.84e0.94)* 0.91 (0.85e0.96)* 0.98 (0.92e1.04)
Logis ic eg ession models s a i ied by gende .
Model 1: isk o low sel - a ed heal h adjus ed by age; Model 2: isk o low sel - a ed heal h adjus ed by age and employmen s a us and Model 3:
isk o low sel - a ed heal h adjus ed by age, employmen s a us and educa ional le el and diagnosed mo bidi y.
OR, odds a ios; 95% CI: 95% con idence in e als.
*Resul s a e s a is ically signi ican .
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PUHE3054_p oo ■17 No embe 2017 ■5/6
Please ci e his a icle in p ess as: Aguila -Palacio I, e al., Recession, employmen and sel - a ed heal h: a s udy on he gende gap,
Public Heal h (2017), h ps://doi.o g/10.1016/j.puhe.2017.10.013

Funding
None decla ed.
Compe ing in e es
None decla ed.
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PUHE3054_p oo ■17 No embe 2017 ■6/6
Please ci e his a icle in p ess as: Aguila -Palacio I, e al., Recession, employmen and sel - a ed heal h: a s udy on he gende gap,
Public Heal h (2017), h ps://doi.o g/10.1016/j.puhe.2017.10.013