Unemployment, public-sector healthcare spending and stomach cancer mortality in the European Union, 1981-2009
Maruthappu M., Painter A., Watkins J., Williams C., Ali R., Zeltner T., Faiz O., Sheth H.
© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. 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.