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Unemployment, public-sector health-care spending and breast cancer mortality in the European Union: 1990-2009.

Abstract：

BACKGROUND:The global economic crisis has been associated with increased unemployment, reduced health-care spending and adverse health outcomes. Insights into the impact of economic variations on cancer mortality, however, remain limited. METHODS:We used multivariate regression analysis to assess how changes in unemployment and public-sector expenditure on health care (PSEH) varied with female breast cancer mortality in the 27 European Union member states from 1990 to 2009. We then determined how the association with unemployment was modified by PSEH. Country-specific differences in infrastructure and demographic structure were controlled for, and 1-, 3-, 5- and 10-year lag analyses were conducted. Several robustness checks were also implemented. RESULTS:Unemployment was associated with an increase in breast cancer mortality [P < 0.0001, coefficient (R) = 0.1829, 95% confidence interval (CI) 0.0978-0.2680]. Lag analysis showed a continued increase in breast cancer mortality at 1, 3, 5 and 10 years after unemployment rises (P < 0.05). Controlling for PSEH removed this association (P = 0.063, R = 0.080, 95% CI -0.004 to 0.163). PSEH increases were associated with significant decreases in breast cancer mortality (P < 0.0001, R = -1.28, 95% CI -1.67 to -0.877). The association between unemployment and breast cancer mortality remained in all robustness checks. CONCLUSION:Rises in unemployment are associated with significant short- and long-term increases in breast cancer mortality, while increases in PSEH are associated with reductions in breast cancer mortality. Initiatives that bolster employment and maintain total health-care expenditure may help minimize increases in breast cancer mortality during economic crises.

journal_name

Eur J Public Health

journal_title

European journal of public health

authors

Maruthappu M,Watkins JA,Waqar M,Williams C,Ali R,Atun R,Faiz O,Zeltner T

doi

10.1093/eurpub/cku167

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

330-5

issue

2

eissn

1101-1262

issn

1464-360X

pii

cku167

journal_volume

25

pub_type

杂志文章

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