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

1990-2009

Mahiben Maruthappu, Johnathan A. Watkins, Mueez Waqar, Callum Williams, Raghib Ali, Rifat Atun, Omar Faiz, Thomas Zeltner

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)330-335
Number of pages6
JournalEuropean Journal of Public Health
Volume25
Issue number2
DOIs
StatePublished - Jan 1 2015

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Unemployment
Public Sector
European Union
Public Health
Breast Neoplasms
Health Expenditures
Delivery of Health Care
Mortality
Economics
Confidence Intervals
Multivariate Analysis
Regression Analysis
Demography
Health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Unemployment, public-sector health-care spending and breast cancer mortality in the European Union : 1990-2009. / Maruthappu, Mahiben; Watkins, Johnathan A.; Waqar, Mueez; Williams, Callum; Ali, Raghib; Atun, Rifat; Faiz, Omar; Zeltner, Thomas.

In: European Journal of Public Health, Vol. 25, No. 2, 01.01.2015, p. 330-335.

Research output: Contribution to journalArticle

Maruthappu, Mahiben ; Watkins, Johnathan A. ; Waqar, Mueez ; Williams, Callum ; Ali, Raghib ; Atun, Rifat ; Faiz, Omar ; Zeltner, Thomas. / Unemployment, public-sector health-care spending and breast cancer mortality in the European Union : 1990-2009. In: European Journal of Public Health. 2015 ; Vol. 25, No. 2. pp. 330-335.
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