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Economic crisis, unemployment rates drive excess cancer deaths
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The 2008 to 2010 global economic crisis appeared associated with 260,000 excess cancer deaths in member states of the Organization for Economic Cooperation and Development, according to the results of a longitudinal study.
Universal health care and increases to public-sector expenditures on health care reduced cancer mortality, results showed.
Graham A. Colditz
The economic crisis that occurred between 2008 and 2010 has been linked to increased unemployment and reductions to public-sector health expenditures.
“That there are needless deaths is a major societal concern,” Rifat Atun, MBBS, MBA, FRCP, professor of global health systems at Harvard T.H. Chan School of Public Health, said in a press release. “Higher unemployment and austerity measures are associated with a higher number of cancer deaths.”
Atun and colleagues conducted their unemployment analysis using World Bank and WHO 1990 to 2010 data from 75 high- and middle-income countries, which represented 2.106 billion people. Researchers had information on public-sector health expenditures from four additional countries, representing 2.156 billion people. Countries with and without universal health coverage were included.
The researchers aggregated mortality data for several “treatable cancers,” defined as cancers with a survival rate of 50% or greater. These included breast cancer in women, prostate cancer in men, and colorectal cancer in both sexes.
Researchers further aggregated data from “untreatable” cancers — defined as cancers with 5-year survival rates lower than 10% and which included pancreatic cancer and lung cancer — in men and women.
Multivariable analyses controlled for country-specific demographics and infrastructure, and assessed the relation between unemployment, public-sector health expenditures and cancer mortality.
A 1% rise in unemployment increased mortality from prostate cancer (regression coefficient [R] = 0.09; 95% CI, 0.3-0.16), breast cancer in women (R = 0.15; 95% CI, 0.11-0.2), lung cancer in men (R = 0.22; 95% CI, 0.12-0.33), and colorectal cancer in men (R = 0.05; 95% CI, 0.01-0.1) and women (R = 0.06; 95% CI, 0.03-0.9). There was a negative association between unemployment and mortality from lung cancer in women.
Overall, treatable cancer mortality increased with greater unemployment (R = 0.12; 95% CI, 0.01-0.23), but this association did not reach significance for untreatable cancers.
These associations persisted among treatable cancers 5 years after unemployment increases.
However, analyses controlled for universal health coverage status by country showed no significant association between cancer mortality and unemployment within the first year of unemployment increases.
In contrast, significant decreases in all-cancer mortality, treatable cancer mortality, and specific cancer mortality occurred when public-sector health expenditures increased.
When the researchers restricted their dataset to countries belonging to the Organization for Economic Cooperation and Development, they calculated a point estimate of 263,221 excess deaths due to cancer. The majority of deaths occurred in countries lacking universal health coverage.
The researchers acknowledged study limitations, including their inability to account for regional and subregional variations in health outcomes. They further noted that the lack of data from China, India and low-income countries limited the global reach of the study.
“Cancer is a leading cause of death worldwide, so understanding how economic changes affect cancer survival is crucial,” Mahiben Maruthappu, MBChB, MA, senior fellow to the CEO of NHS England, said in a press release. “We also found that public health care spending was tightly associated with cancer mortality — suggesting that health care cuts could cost lives.”
These data suggest that universal health coverage should be considered in the United States, Graham A. Colditz, MD, DrPH, MPH, deputy director of the Institute of Public Health and professor of surgery at Washington University School of Medicine, and Karen M. Emmons, PhD, vice president for research and director of Kaiser Permanente Research Institute, wrote in an accompanying editorial.
“Although in many countries universal health coverage is seen as an important societal investment, so far this has not been the case in the United States,” Colditz and Emmons wrote. “The country might find the promise of improving coverage to those affected by cancer. Universal health coverage, specifically for all patients with cancer, would meet the Institute for Medicine recommendation to reduce disparities in access to cancer care for vulnerable and underserved populations. Furthermore, universal cancer coverage would generate a great return on investment.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures. Colditz reports no relevant financial disclosures. Emmons reports an employment role with Kaiser Permanente.
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