title: Unemployment, public-sector healthcare expenditure and colorectal cancer mortality in the European Union: 1990-2009.
abstract: OBJECTIVE
  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.
authors: Imperial College London, London, SW7 2AZ, UK.|Harvard University, Cambridge, MA, 02138, USA.|Faculty of Arts and Sciences, Harvard University, Cambridge, MA, 02137, USA.
authors: Mahiben
authors: M
authors: Maruthappu
authors: Imperial College London, London, SW7 2AZ, UK. robert.watson@doctors.org.uk.
authors: Robert A
authors: RA
authors: Watson
authors: Institute for Mathematical and Molecular Biomedicine, King's College London, London, SE1 1UL, UK.
authors: Johnathan
authors: J
authors: Watkins
authors: The Economist, 25 St James's Street, London, SW1A 1HG, UK.|Faculty of History, University of Oxford, George Street, Oxford, OX1 2RL, UK.
authors: Callum
authors: C
authors: Williams
authors: University of Bern, Gerechtigkeitsgasse 31, 3011, Bern, Switzerland.
authors: Thomas
authors: T
authors: Zeltner
authors: Imperial College London, London, SW7 2AZ, UK.|St Mark's Hospital and Academic Institute, Harrow, Middlesex, HA1 3UJ, UK.
authors: Omar
authors: O
authors: Faiz
authors: Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK.|Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab Emirates.
authors: Raghib
authors: R
authors: Ali
authors: Harvard School of Public Health, Harvard University, Cambridge, MA, USA.|Faculty of Arts and Sciences, Harvard University, Cambridge, MA, 02137, USA.
authors: Rifat
authors: R
authors: Atun
mesh_terms: D015179:Colorectal Neoplasms / Q000401:mortality*; D055088:Early Detection of Cancer; D005062:European Union; D005260:Female; D005380:Financing, Government / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017150:Public Sector / Q000191:economics*; D012044:Regression Analysis; D012189:Retrospective Studies; D014478:Unemployment / Q000706:statistics & numerical data*
keywords: Cancer mortality; Colorectal cancer; European Union; Healthcare spending; Unemployment