Journal of Community Health

, Volume 36, Issue 4, pp 574–582 | Cite as

Macro Determinants of Cause-Specific Injury Mortality in the OECD Countries: An Exploration of the Importance of GDP and Unemployment

  • Sana Muazzam
  • Muazzam Nasrullah
Original paper


Gross Domestic Product (GDP) and unemployment has a strong documented impact on injury mortality. The aim of our study is to investigate the relationship of GDP per capita and unemployment with gender- and cause-specific injury mortalities in the member nations of Organization for Economic Cooperation and Development (OECD). Country-based data on injury mortality per 100,000 population, including males and females aged 1–74, for the 4 year period 1996–1999, were gathered from the World Health Organization’s Statistical Information System. We selected fourteen cause-specific injury mortalities. Data on GDP, unemployment rate and population growth were taken from World Development Indicators. GDP and unemployment rate per 100 separately were regressed on total and cause-specific injury mortality rate per 100,000 for males and females. Overall in the OECD countries, GDP per capita increased 12.5% during 1996–1999 (P = 0.03) where as unemployment rate decreased by 12.3% (P = 0.05). Among males, most cause-specific injury mortality rates decreased with increasing GDP except motor vehicle traffic crashes (MTC) that increased with increasing GDP (coefficient = 0.75; P < 0.001). Similar trend was found in females, except suicidal injury mortalities that also increased with increasing GDP (coefficient = 0.31; P = 0.04). When we modeled cause-specific injury mortality rates with unemployment, injuries due to firearm missiles (coefficient = 0.53; P < 0.001), homicide (coefficient = 0.36; P < 0.001), and other violence (coefficient = 0.41; P < 0.001) increased with increase in unemployment rate among males. However, among females only accidental falls (coefficient = 0.36; P = 0.01) were found significantly associated with increasing unemployment rate. GDP is more related to cause-specific injury mortality than unemployment. Injury mortality does not relate similarly to each diagnosis-specific cause among males and females. Further research on causation with more predictors is needed.


Injury Mortality GDP Unemployment OECD 


Conflict of Interest



  1. 1.
    World Health Organization. (WHO). New publications show injuries kill more than five million people a year [cited 2010 February 20]; Available from:
  2. 2.
    Moniruzzaman, S., & Andersson, R. (2005). Relationship between economic development and risk of injuries in older adults and the elderly. A global analysis of unintentional injury mortality in an epidemiologic transition perspective. European Journal of Public Health, 15(5), 454–458.PubMedCrossRefGoogle Scholar
  3. 3.
    Krug, E. G., Sharma, G. K., & Lozano, R. (2000). The global burden of injuries. American Journal of Public Health, 90(4), 523–526.PubMedCrossRefGoogle Scholar
  4. 4.
    Coles, O. B. (2005). Relationship between economic development and suicide mortality: A global cross-sectional analysis in an epidemiological transition perspective by Moniruzzaman and Andersson (Public Health, 118(5), 346–348). Public Health, 119(1), 71–72; author reply 72–73.Google Scholar
  5. 5.
    Moniruzzaman, S., & Andersson, R. (2008). Economic development as a determinant of injury mortality—a longitudinal approach. Social Science and Medicine, 66(8), 1699–1708.PubMedCrossRefGoogle Scholar
  6. 6.
    Moniruzzaman, S., & Andersson, R. (2004). Relationship between economic development and suicide mortality: A global cross-sectional analysis in an epidemiological transition perspective. Public Health, 118(5), 346–348.PubMedCrossRefGoogle Scholar
  7. 7.
    Gerdtham, U. G., & Ruhm, C. J. (2006). Deaths rise in good economic times: Evidence from the OECD. Economics and Human Biology, 4(3), 298–316.PubMedCrossRefGoogle Scholar
  8. 8.
    Gerdtham, U. G., & Johannesson, M. (2003). A note on the effect of unemployment on mortality. Journal of Health Economics, 22(3), 505–518.PubMedCrossRefGoogle Scholar
  9. 9.
    Brenner, M. H. (1979). Mortality and the national economy. A review, and the experience of England and Wales, 1936–1976. Lancet, 2(8142), 568–573.PubMedCrossRefGoogle Scholar
  10. 10.
    Neumayer, E. (2004). Recessions lower (some) mortality rates: Evidence from Germany. Social Science and Medicine, 58(6), 1037–1047.PubMedCrossRefGoogle Scholar
  11. 11.
    World Health Organization. (2003). WHO statistical information systems (WHOSIS), Geneva. Google Scholar
  12. 12.
    Ahmed, N., & Andersson, R. (2002). Differences in cause-specific patterns of unintentional injury mortality among 15–44-year-olds in income-based country groups. Accident Analysis and Prevention, 34(4), 541–551.PubMedCrossRefGoogle Scholar
  13. 13.
    Nasrullah, M., Laflamme, L., & Khan, J. (2008). Does economic level similarly matter for injury mortality in the OECD and non-OECD countries? Safety Science, 46, 784–791.CrossRefGoogle Scholar
  14. 14.
    Moniruzzaman, S., & Andersson, R. (2008). Cross-national injury mortality differentials by income level: The possible role of age and ageing. Public Health, 122(11), 1167–1176.PubMedCrossRefGoogle Scholar
  15. 15.
    Jansson, B., & Svanstrom, L. (1995). National inequalities in accident mortality among children and adolescents in the European countries. In B. Lindstrom & N. Spencer (Eds.), Social paediatrics (pp. 174–191). Oxford University Press: Oxford.Google Scholar
  16. 16.
    Bishai, D., Quresh, A., James, P., & Ghaffar, A. (2006). National road casualties and economic development. Health Economics, 15(1), 65–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Owens, D. A., & Sivak, M. (1996). Differentiation of visibility and alcohol as contributors to twilight road fatalities. Human Factors, 38(4), 680–689.PubMedCrossRefGoogle Scholar
  18. 18.
    Plainis, S., Murray, I. J., & Pallikaris, I. G. (2006). Road traffic casualties: Understanding the night-time death toll. Injury Prevention, 12(2), 125–128.PubMedCrossRefGoogle Scholar
  19. 19.
    Massie, D. L., Green, P. E., & Campbell, K. L. (1997). Crash involvement rates by driver gender and the role of average annual mileage. Accident Analysis and Prevention, 29(5), 675–685.PubMedCrossRefGoogle Scholar
  20. 20.
    Massie, D. L., Campbell, K. L., & Williams, A. F. (1995). Traffic accident involvement rates by driver age and gender. Accident Analysis and Prevention, 27(1), 73–87.PubMedCrossRefGoogle Scholar
  21. 21.
    World Health Organization. (2010). The global burden of disease: 2004 update: Geneva. 2008 [cited 2010 September 23]. Available from
  22. 22.
    World Health Organization and Regional office for Europe. (2003). Mental health in the WHO European Region. 2003 [cited 2010 April 11]. Available from:
  23. 23.
    Ostamo, A., Lahelma, E., & Lonnqvist, J. (2001). Transitions of employment status among suicide attempters during a severe economic recession. Social Science and Medicine, 52(11), 1741–1750.PubMedCrossRefGoogle Scholar
  24. 24.
    Wasserman, D., & Varnik, A. (1998). Reliability of statistics on violent death and suicide in the former USSR, 1970–1990. Acta Psychiatrica Scandinavica. Supplementum, 394, 34–41.PubMedCrossRefGoogle Scholar
  25. 25.
    Young, T. W., Wooden, S. E., Dew, P. C., Hoff, G. L., & Cai, J. (2005). The Richard Cory phenomenon: Suicide and wealth in Kansas City, Missouri. Journal of Forensic Sciences, 50(2), 443–447.PubMedCrossRefGoogle Scholar
  26. 26.
    Yamasaki, A., Sakai, R., & Shirakawa, T. (2005). Low income, unemployment, and suicide mortality rates for middle-age persons in Japan. Psychological Reports, 96(2), 337–348.PubMedCrossRefGoogle Scholar
  27. 27.
    Fukuda, Y., Nakamura, K., & Takano, T. (2005). Cause-specific mortality differences across socioeconomic position of municipalities in Japan, 1973–1977 and 1993–1998: Increased importance of injury and suicide in inequality for ages under 75. International Journal of Epidemiology, 34(1), 100–109.PubMedCrossRefGoogle Scholar
  28. 28.
    Reed, J. A., Smith, R. S., Helmer, S. D., Lancaster, B. A., & Carman, C. G. (2003). Rates of unemployment and penetrating trauma are correlated. Southern Medical Journal, 96(8), 772–774.PubMedCrossRefGoogle Scholar
  29. 29.
    Yang, B., & Lester, D. (1992). Suicide, homicide and unemployment: A methodological note. Psychological Reports, 71(3 Pt 1), 844–846.Google Scholar
  30. 30.
    Sengoelge, M., Hasselberg, M., & Laflamme, L. (2010). Child home injury mortality in Europe: A 16-country analysis. European Journal of Public Health.Google Scholar
  31. 31.
    Were, M. (2001). The impact of external debt on economic growth and private investments in Kenya: An empirical assessment (cited 2010 April 11). Available from:
  32. 32.
    Fiscella, K., & Franks, P. (1997). Poverty or income inequality as predictor of mortality: Longitudinal cohort study. BMJ, 314(7096), 1724–1727.PubMedGoogle Scholar
  33. 33.
    Pickett, K. E., Mookherjee, J., & Wilkinson, R. G. (2005). Adolescent birth rates, total homicides, and income inequality in rich countries. American Journal of Public Health, 95(7), 1181–1183.PubMedCrossRefGoogle Scholar
  34. 34.
    Macinko, J., Starfield, B., & Shi, L. (2003). The contribution of primary care systems to health outcomes within organization for economic cooperation and development (OECD) countries, 1970–1998. Health Services Research, 38(3), 831–865.PubMedCrossRefGoogle Scholar
  35. 35.
    World Health Organization. World health statistics annuals, 1993–1996. World Health Organization, Geneva, 1994–1996.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Injury Control Research Center, West Virginia UniversityMorgantownUSA
  2. 2.Department of Community Medicine, West Virginia University School of Medicine, Health Science CenterMorgantownUSA
  3. 3.Centers for Disease Control and Prevention (CDC)AtlantaUSA

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