Unemployment, public-sector healthcare spending and stomach cancer mortality in the European Union, 1981-2009

Mahiben Maruthappu, Annabelle Painter, Johnathan Watkins, Callum Williams, Raghib Ali, Thomas Zeltner, Omar Faiz, Hemant Sheth

    Research output: Contribution to journalArticle

    Abstract

    Objectives We sought to determine the association between changes in unemployment, healthcare spending and stomach cancer mortality. Methods Multivariate regression analysis was used to assess how changes in unemployment and public-sector expenditure on healthcare (PSEH) varied with stomach cancer mortality in 25 member states of the European Union from 1981 to 2009. Country-specific differences in healthcare infrastructure and demographics were controlled for 1- to 5-year time-lag analyses and robustness checks were carried out. Results A 1% increase in unemployment was associated with a significant increase in stomach cancer mortality in both men and women [men: coefficient (R) =0.1080, 95% confidence interval (CI)= 0.0470-0.1690, P=0.0006; women: R=0.0488, 95% CI=0.0168-0.0809, P =0.0029]. A 1% increase in PSEH was associated with a significant decrease in stomach cancer mortality (men: R= -0.0009, 95% CI=-0.0013 to -0.005, P<0.0001; women: R =-0.0004, 95% CI=-0.0007 to -0.0001, P= 0.0054). The associations remained when economic factors, urbanization, nutrition and alcohol intake were controlled for, but not when healthcare resources were controlled for. Time-lag analysis showed that the largest changes in mortality occurred 3-4 years after any changes in either unemployment or PSEH. Conclusion Increases in unemployment are associated with a significant increase in stomach cancer mortality. Stomach cancer mortality is also affected by public-sector healthcare spending. Initiatives that bolster employment and maintain public-sector healthcare expenditure may help to minimize increases in stomach cancer mortality during economic downturns.

    Original languageEnglish (US)
    Pages (from-to)1222-1227
    Number of pages6
    JournalEuropean Journal of Gastroenterology and Hepatology
    Volume26
    Issue number11
    DOIs
    StatePublished - Jan 1 2014

    Fingerprint

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

    Keywords

    • Government spending
    • Health economics
    • Mortality
    • Stomach cancer
    • Unemployment

    ASJC Scopus subject areas

    • Hepatology
    • Gastroenterology

    Cite this

    Unemployment, public-sector healthcare spending and stomach cancer mortality in the European Union, 1981-2009. / Maruthappu, Mahiben; Painter, Annabelle; Watkins, Johnathan; Williams, Callum; Ali, Raghib; Zeltner, Thomas; Faiz, Omar; Sheth, Hemant.

    In: European Journal of Gastroenterology and Hepatology, Vol. 26, No. 11, 01.01.2014, p. 1222-1227.

    Research output: Contribution to journalArticle

    Maruthappu, Mahiben ; Painter, Annabelle ; Watkins, Johnathan ; Williams, Callum ; Ali, Raghib ; Zeltner, Thomas ; Faiz, Omar ; Sheth, Hemant. / Unemployment, public-sector healthcare spending and stomach cancer mortality in the European Union, 1981-2009. In: European Journal of Gastroenterology and Hepatology. 2014 ; Vol. 26, No. 11. pp. 1222-1227.
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    abstract = "Objectives We sought to determine the association between changes in unemployment, healthcare spending and stomach cancer mortality. Methods Multivariate regression analysis was used to assess how changes in unemployment and public-sector expenditure on healthcare (PSEH) varied with stomach cancer mortality in 25 member states of the European Union from 1981 to 2009. Country-specific differences in healthcare infrastructure and demographics were controlled for 1- to 5-year time-lag analyses and robustness checks were carried out. Results A 1{\%} increase in unemployment was associated with a significant increase in stomach cancer mortality in both men and women [men: coefficient (R) =0.1080, 95{\%} confidence interval (CI)= 0.0470-0.1690, P=0.0006; women: R=0.0488, 95{\%} CI=0.0168-0.0809, P =0.0029]. A 1{\%} increase in PSEH was associated with a significant decrease in stomach cancer mortality (men: R= -0.0009, 95{\%} CI=-0.0013 to -0.005, P<0.0001; women: R =-0.0004, 95{\%} CI=-0.0007 to -0.0001, P= 0.0054). The associations remained when economic factors, urbanization, nutrition and alcohol intake were controlled for, but not when healthcare resources were controlled for. Time-lag analysis showed that the largest changes in mortality occurred 3-4 years after any changes in either unemployment or PSEH. Conclusion Increases in unemployment are associated with a significant increase in stomach cancer mortality. Stomach cancer mortality is also affected by public-sector healthcare spending. Initiatives that bolster employment and maintain public-sector healthcare expenditure may help to minimize increases in stomach cancer mortality during economic downturns.",
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    T1 - Unemployment, public-sector healthcare spending and stomach cancer mortality in the European Union, 1981-2009

    AU - Maruthappu, Mahiben

    AU - Painter, Annabelle

    AU - Watkins, Johnathan

    AU - Williams, Callum

    AU - Ali, Raghib

    AU - Zeltner, Thomas

    AU - Faiz, Omar

    AU - Sheth, Hemant

    PY - 2014/1/1

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    N2 - Objectives We sought to determine the association between changes in unemployment, healthcare spending and stomach cancer mortality. Methods Multivariate regression analysis was used to assess how changes in unemployment and public-sector expenditure on healthcare (PSEH) varied with stomach cancer mortality in 25 member states of the European Union from 1981 to 2009. Country-specific differences in healthcare infrastructure and demographics were controlled for 1- to 5-year time-lag analyses and robustness checks were carried out. Results A 1% increase in unemployment was associated with a significant increase in stomach cancer mortality in both men and women [men: coefficient (R) =0.1080, 95% confidence interval (CI)= 0.0470-0.1690, P=0.0006; women: R=0.0488, 95% CI=0.0168-0.0809, P =0.0029]. A 1% increase in PSEH was associated with a significant decrease in stomach cancer mortality (men: R= -0.0009, 95% CI=-0.0013 to -0.005, P<0.0001; women: R =-0.0004, 95% CI=-0.0007 to -0.0001, P= 0.0054). The associations remained when economic factors, urbanization, nutrition and alcohol intake were controlled for, but not when healthcare resources were controlled for. Time-lag analysis showed that the largest changes in mortality occurred 3-4 years after any changes in either unemployment or PSEH. Conclusion Increases in unemployment are associated with a significant increase in stomach cancer mortality. Stomach cancer mortality is also affected by public-sector healthcare spending. Initiatives that bolster employment and maintain public-sector healthcare expenditure may help to minimize increases in stomach cancer mortality during economic downturns.

    AB - Objectives We sought to determine the association between changes in unemployment, healthcare spending and stomach cancer mortality. Methods Multivariate regression analysis was used to assess how changes in unemployment and public-sector expenditure on healthcare (PSEH) varied with stomach cancer mortality in 25 member states of the European Union from 1981 to 2009. Country-specific differences in healthcare infrastructure and demographics were controlled for 1- to 5-year time-lag analyses and robustness checks were carried out. Results A 1% increase in unemployment was associated with a significant increase in stomach cancer mortality in both men and women [men: coefficient (R) =0.1080, 95% confidence interval (CI)= 0.0470-0.1690, P=0.0006; women: R=0.0488, 95% CI=0.0168-0.0809, P =0.0029]. A 1% increase in PSEH was associated with a significant decrease in stomach cancer mortality (men: R= -0.0009, 95% CI=-0.0013 to -0.005, P<0.0001; women: R =-0.0004, 95% CI=-0.0007 to -0.0001, P= 0.0054). The associations remained when economic factors, urbanization, nutrition and alcohol intake were controlled for, but not when healthcare resources were controlled for. Time-lag analysis showed that the largest changes in mortality occurred 3-4 years after any changes in either unemployment or PSEH. Conclusion Increases in unemployment are associated with a significant increase in stomach cancer mortality. Stomach cancer mortality is also affected by public-sector healthcare spending. Initiatives that bolster employment and maintain public-sector healthcare expenditure may help to minimize increases in stomach cancer mortality during economic downturns.

    KW - Government spending

    KW - Health economics

    KW - Mortality

    KW - Stomach cancer

    KW - Unemployment

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    JO - European Journal of Gastroenterology and Hepatology

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