International Journal of Public Health

, Volume 61, Issue 1, pp 119–130 | Cite as

Unemployment, public-sector healthcare expenditure and colorectal cancer mortality in the European Union: 1990–2009

  • Mahiben Maruthappu
  • Robert A. WatsonEmail author
  • Johnathan Watkins
  • Callum Williams
  • Thomas Zeltner
  • Omar Faiz
  • Raghib Ali
  • Rifat Atun
Original Article



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.


Colorectal cancer Cancer mortality Unemployment Healthcare spending European Union 


Compliance with ethical standards

Ethical approval

No ethical approval was required for this study.

Conflict of interest

The authors declare that there are no competing interests.

Supplementary material

38_2015_727_MOESM1_ESM.pdf (95 kb)
Supplementary material 1 (PDF 95 kb)


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Copyright information

© Swiss School of Public Health 2015

Authors and Affiliations

  • Mahiben Maruthappu
    • 1
    • 2
    • 11
  • Robert A. Watson
    • 1
    Email author
  • Johnathan Watkins
    • 3
  • Callum Williams
    • 4
    • 5
  • Thomas Zeltner
    • 6
  • Omar Faiz
    • 1
    • 7
  • Raghib Ali
    • 8
    • 9
  • Rifat Atun
    • 10
    • 11
  1. 1.Imperial College LondonLondonUK
  2. 2.Harvard UniversityCambridgeUSA
  3. 3.Institute for Mathematical and Molecular BiomedicineKing’s College LondonLondonUK
  4. 4.The EconomistLondonUK
  5. 5.Faculty of HistoryUniversity of OxfordOxfordUK
  6. 6.University of BernBernSwitzerland
  7. 7.St Mark’s Hospital and Academic InstituteMiddlesexUK
  8. 8.Cancer Epidemiology UnitUniversity of OxfordOxfordUK
  9. 9.Faculty of Medicine and Health SciencesUnited Arab Emirates UniversityAl-AinUnited Arab Emirates
  10. 10.Harvard School of Public HealthHarvard UniversityCambridgeUSA
  11. 11.Faculty of Arts and SciencesHarvard UniversityCambridgeUSA

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