title: Unemployment and prostate cancer mortality in the OECD, 1990-2009.
abstract: The global economic downturn has been associated with increased unemployment in many countries. Insights into the impact of unemployment on specific health conditions remain limited. We determined the association between unemployment and prostate cancer mortality in members of the Organisation for Economic Co-operation and Development (OECD). We used multivariate regression analysis to assess the association between changes in unemployment and prostate cancer mortality in OECD member states between 1990 and 2009. Country-specific differences in healthcare infrastructure, population structure, and population size were controlled for and lag analyses conducted. Several robustness checks were also performed. Time trend analyses were used to predict the number of excess deaths from prostate cancer following the 2008 global recession. Between 1990 and 2009, a 1% rise in unemployment was associated with an increase in prostate cancer mortality. Lag analysis showed a continued increase in mortality years after unemployment rises. The association between unemployment and prostate cancer mortality remained significant in robustness checks with 46 controls. Eight of the 21 OECD countries for which a time trend analysis was conducted, exhibited an estimated excess of prostate cancer deaths in at least one of 2008, 2009, or 2010, based on 2000-2007 trends. Rises in unemployment are associated with significant increases in prostate cancer mortality. Initiatives that bolster employment may help to minimise prostate cancer mortality during times of economic hardship.
authors.affiliation: Faculty of Medicine, Imperial College London, London SW7 2AZ, UK ;
authors.forename: Mahiben
authors.initials: M
authors.lastname: Maruthappu
authors.affiliation: Institute for Mathematical and Molecular Biomedicine, King's College London, London SE1 1UL, UK ;
authors.forename: Johnathan
authors.initials: J
authors.lastname: Watkins
authors.affiliation: Medical Sciences Division, University of Oxford, OX1 2JD, UK.
authors.forename: Abigail
authors.initials: A
authors.lastname: Taylor
authors.affiliation: The Economist, 25 St James's Street, London SW1A 1HG, UK.
authors.forename: Callum
authors.initials: C
authors.lastname: Williams
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford OX3 7LF, UK ; Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, United Arab Emirates.
authors.forename: Raghib
authors.initials: R
authors.lastname: Ali
authors.affiliation: Special Envoy for Financing to the Director General of the World Health Organization (WHO), 1211 Geneva 27, Switzerland ; University of Bern, Bern CH 3011, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeltner
authors.affiliation: Faculty of Medicine, Imperial College London, London SW7 2AZ, UK ; Harvard School of Public Health, Harvard University, MA 02115, USA.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
keywords: economic crisis; health economics; mortality; prostate cancer; unemployment