Mahiben Maruthappu1,2,3, Robert A Watson4, Johnathan Watkins5, Callum Williams6,7, Thomas Zeltner8, Omar Faiz1,9, Raghib Ali10,11, Rifat Atun12,3. 1. Imperial College London, London, SW7 2AZ, UK. 2. Harvard University, Cambridge, MA, 02138, USA. 3. Faculty of Arts and Sciences, Harvard University, Cambridge, MA, 02137, USA. 4. Imperial College London, London, SW7 2AZ, UK. robert.watson@doctors.org.uk. 5. Institute for Mathematical and Molecular Biomedicine, King's College London, London, SE1 1UL, UK. 6. The Economist, 25 St James's Street, London, SW1A 1HG, UK. 7. Faculty of History, University of Oxford, George Street, Oxford, OX1 2RL, UK. 8. University of Bern, Gerechtigkeitsgasse 31, 3011, Bern, Switzerland. 9. St Mark's Hospital and Academic Institute, Harrow, Middlesex, HA1 3UJ, UK. 10. Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK. 11. Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab Emirates. 12. Harvard School of Public Health, Harvard University, Cambridge, MA, USA.
Abstract
OBJECTIVES: We examined the association between unemployment and government spending on healthcare with colorectal cancer mortality. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVES: We examined the association between unemployment and government spending on healthcare with colorectal cancer mortality. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Entities:
Keywords:
Cancer mortality; Colorectal cancer; European Union; Healthcare spending; Unemployment
Authors: J D Hardcastle; J O Chamberlain; M H Robinson; S M Moss; S S Amar; T W Balfour; P D James; C M Mangham Journal: Lancet Date: 1996-11-30 Impact factor: 79.321
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