OBJECTIVE: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. METHODS: This is an ecological study of trends in three periods of time: two before (2000-2003 and 2004-2008), and one after (2009-2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. RESULTS: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. CONCLUSIONS: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term.

Agència de Salut Pública de Barcelona 08023 Barcelona Spain

Centre of Studies in Geography and Spatial Planning University of Coimbra 3000 370 Coimbra Portugal

CIBER Epidemiología y Salud Pública 20029 Madrid Spain

Department of Experimental Sciences and Health Universitat Pompeu Fabra 08003 Barcelona Spain

Department of Geography and Tourism University of Coimbra 3000 370 Coimbra Portugal

Department of Health Psychology and Research Methodology Medical Faculty P J Safarik University of Kosice 04180 Kosice Slovakia

Department of Hygiene Epidemiology and Medical Statistics Medical School National and Kapodistrian University of Athens 106 79 Athens Greece

Department of Sociology Interface Demography Vrije Universiteit Brussel 1050 Brussels Belgium

Faculty of Science Charles University 116 36 Prague Czech Republic

Institut d'Investigació Biomèdica 08003 Barcelona Spain

Institute of Health Equity at the Research Department of Epidemiology and Public Health University College London London WC1E 6BT UK

Olomouc University Social Health Institute Palacky University in Olomouc CZ 77900 Olomouc Czech Republic

Service of Environmental Quality and Interventions Agència de Salut Pública de Barcelona 08023 Barcelona Spain

Service of Health Information Systems Agència de Salut Pública de Barcelona 08023 Barcelona Spain

Service of Prevention and Care of Drug Addictions Agència de Salut Pública de Barcelona 08023 Barcelona Spain

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