Unemployment, public-sector healthcare expenditure and colorectal cancer mortality in the European Union: 1990–2009
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We examined the association between unemployment and government spending on healthcare with colorectal cancer mortality.
Retrospective observational study using data from the World Bank and WHO. Multivariate regression analysis was used, controlling for country-specific differences in infrastructure and demographics.
A 1 % increase in unemployment was associated with a significant increase in colorectal cancer mortality in both men and women [men: coefficient (R) = 0.0995, 95 % confidence interval (CI) 0.0132–0.1858, P = 0.024; women: R = 0.0742, 95 % CI 0.0160–0.1324, P = 0.013]. A 1 % increase in government spending on healthcare was associated with a statistically significant decrease in colorectal cancer mortality across both sexes (men: R = −0.4307, 95 % CI −0.6057 to −0.2557, P < 0.001; women: R = −0.2162, 95 % CI −0.3407 to −0.0917, P = 0.001). The largest changes in mortality occurred 3–4 years following changes in either economic variable.
Unemployment rises are associated with a significant increase in colorectal cancer mortality, whilst government healthcare spending rises are associated with falling mortality. This is likely due, in part, to reduced access to healthcare services and has major implications for clinicians and policy makers alike.
KeywordsColorectal cancer Cancer mortality Unemployment Healthcare spending European Union
Compliance with ethical standards
No ethical approval was required for this study.
Conflict of interest
The authors declare that there are no competing interests.
- European Parliamentary Research Service. Social Dimension of Austerity Measures (2013). http://www.europarl.europa.eu/RegData/bibliotheque/briefing/2013/130694/LDM_BRI(2013)130694_REV1_EN.pdf. Accessed 22 April 2015
- Eurostat (2013a) Population Data. Available at http://epp.eurostat.ec.europa.eu/. Accessed 22nd April 2015
- Eurostat (2013b) Unemployment statistics. Available at http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Unemployment_statistics. Accessed 22 April 2015
- International Labour Organisation (2011) World Social Security Report 2010/11. http://www.ilo.org/gimi/gess/RessourceDownload.action?ressource.ressourceId=15464. Accessed 22 April 2015
- Lee SJ, Boscardin WJ, Stijacic-Cenzer I, Conell-Price J, O’Brien S, Walter LC (2013) Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ 346:e8441. doi: 10.1136/bmj.e8441 PubMedCrossRefGoogle Scholar
- Lian M, Schootman M, Doubeni CA et al (2011) Geographic variation in colorectal cancer survival and the role of small-area socioeconomic deprivation: a multilevel survival analysis of the NIH-AARP Diet and Health Study Cohort. Am J Epidemiol 174(7):828–838. doi: 10.1093/aje/kwr162 PubMedPubMedCentralCrossRefGoogle Scholar
- OECD iLibrary, OECD Statistics 2012, Screening, Survival and Mortality for Colorectal Cancer. Available at http://www.oecd-ilibrary.org/sites/9789264183896-en/04/04/03/index.html;jsessionid=2ukd1ljrgg7.x-oecd-live-01?contentType=&itemId=/content/chapter/9789264183896-48-en&containerItemId=/content/serial/23056088&accessItemIds=/content/book/9789264183896-en&mimeType=text/html. Accessed 22 April 2015
- Singh GK MB, Hankey BF et al (2003) Area socioeconomic variations in US cancer incidence, mortality, stage, treatment, and survival, 1975–1999. National Cancer Institute, BethesdaGoogle Scholar
- Stuckler D, Basu S (2013) The body economic: why austerity kills. Basic BooksGoogle Scholar
- Thomson SJM, Evetovits T, Jakab M, McKee M, Figueras J (2013) Summary: health, health systems and economic crisis in Europe. Impact and policy implications. World Health Organization on behalf of the European Observatory on Health Syatems and Policies, BrusselsGoogle Scholar