title: Impact of State Public Health Spending on Disease Incidence in the United States from 1980 to 2009.
abstract: To understand the relationship between state-level spending by public health departments and the incidence of three vaccine preventable diseases (VPDs): mumps, pertussis, and rubella in the United States from 1980 to 2009.
  
  
  
  This study uses state-level public health spending data from The Census Bureau and annual mumps, pertussis, and rubella incidence counts from the University of Pittsburgh's project Tycho.
  
  
  
  Ordinary least squares (OLS), fixed effects, and random effects regression models were tested, with results indicating that a fixed effects model would be most appropriate model for this analysis.
  
  
  
  Model output suggests a statistically significant, negative relationship between public health spending and mumps and rubella incidence. Lagging outcome variables indicate that public health spending actually has the greatest impact on VPD incidence in subsequent years, rather than the year in which the spending occurred. Results were robust to models with lagged spending variables, national time trends, and state time trends, as well as models with and without Medicaid and hospital spending.
  
  
  
  Our analysis indicates that there is evidence of a significant, negative relationship between a state's public health spending and the incidence of two VPDs, mumps and rubella, in the United States.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Reetu
authors.initials: R
authors.lastname: Verma
authors.affiliation: International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Samantha
authors.initials: S
authors.lastname: Clark
authors.affiliation: Office of Public Health Practice and Training, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leider
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: David
authors.initials: D
authors.lastname: Bishai
mesh_terms: D005380:Financing, Government / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D016018:Least-Squares Analysis; D009107:Mumps / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D011634:Public Health / Q000191:economics* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012409:Rubella / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D013219:State Government; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014917:Whooping Cough / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control
keywords: CHIP; Tycho; VFC; vaccination; vaccine preventable diseases