Summary:
Economic downturns, universal health coverage, and cancer mortality in high-income and middle-income countries, 1990–2010: a longitudinal analysis - The Lancet
Published Online: 25 May 2016
Background
The
global economic crisis has been associated with increased unemployment
and reduced public-sector expenditure on health care (PEH). We estimated
the effects of changes in unemployment and PEH on cancer mortality, and
identified how universal health coverage (UHC) affected these
relationships.
Methods
For this
longitudinal analysis, we obtained data from the World Bank and WHO
(1990–2010). We aggregated mortality data for breast cancer in women,
prostate cancer in men, and colorectal cancers in men and women, which
are associated with survival rates that exceed 50%, into a treatable
cancer class. We likewise aggregated data for lung and pancreatic
cancers, which have 5 year survival rates of less than 10%, into an
untreatable cancer class. We used multivariable regression analysis,
controlling for country-specific demographics and infrastructure, with
time-lag analyses and robustness checks to investigate the relationship
between unemployment, PEH, and cancer mortality,
with and without UHC.
We used trend analysis to project mortality rates, on the basis of
trends before the sharp unemployment rise that occurred in many
countries from 2008 to 2010, and compared them with observed rates.
Results
Data
were available for
75 countries, representing 2·106 billion people, for
the unemployment analysis and for
79 countries, representing 2·156
billion people, for the PEH analysis.
Unemployment rises were
significantly associated with an increase in all-cancer mortality and
all specific cancers except lung cancer in women. By contrast,
untreatable cancer mortality was not significantly linked with changes
in unemployment.
Lag analyses showed significant associations remained 5
years after unemployment increases for the treatable cancer class.
Rerunning analyses, while accounting for UHC status, removed the
significant associations. All-cancer, treatable cancer, and specific
cancer mortalities significantly decreased as PEH increased. Time-series
analysis provided an estimate of more than 40 000 excess deaths due to a
subset of treatable cancers from 2008 to 2010, on the basis of 2000–07
trends. Most of these deaths were in non-UHC countries.
Interpretation
Unemployment
increases are associated with rises in cancer mortality; UHC seems to
protect against this effect. PEH increases are associated with reduced
cancer mortality. Access to health care could underlie these
associations. We estimate that the 2008–10 economic crisis was
associated with about 260 000 excess cancer-related deaths in the
Organisation for Economic Co-operation and Development alone.
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