A time-series analysis of the relation between unemployment rate and hospital admission for acute myocardial infarction and stroke in Brazil over more than a decade.
BACKGROUND
The effect of socioeconomic stressors on the incidence of cardiovascular disease (CVD) is currently open to debate. Using time-series analysis, our study aimed to evaluate the relationship between unemployment rate and hospital admission for acute myocardial infarction (AMI) and stroke in Brazil over a recent 11-year span.


RESULTS
Data on monthly hospital admissions for AMI and stroke from March 2002 to December 2013 were extracted from the Brazilian Public Health System Database. The monthly unemployment rate was obtained from the Brazilian Institute for Applied Economic Research, during the same period. The autoregressive integrated moving average (ARIMA) model was used to test the association of temporal series. Statistical significance was set at p<0.05. From March 2002 to December 2013, 778,263 admissions for AMI and 1,581,675 for stroke were recorded. During this time period, the unemployment rate decreased from 12.9% in 2002 to 4.3% in 2013, while admissions due to AMI and stroke increased. However, the adjusted ARIMA model showed a positive association between the unemployment rate and admissions for AMI but not for stroke (estimate coefficient=2.81±0.93; p=0.003 and estimate coefficient=2.40±4.34; p=0.58, respectively).


CONCLUSIONS
From 2002 to 2013, hospital admissions for AMI and stroke increased, whereas the unemployment rate decreased. However, the adjusted ARIMA model showed a positive association between unemployment rate and admissions due to AMI but not for stroke. Further studies are warranted to validate our findings and to better explore the mechanisms by which socioeconomic stressors, such as unemployment, might impact on the incidence of CVD.
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. Electronic address: mkatz@einstein.br.
Marcelo
M
Katz
Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA.
Hayden B
HB
Bosworth
Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
Renato D
RD
Lopes
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA and Department of Community and Family Medicine, Duke University, Durham, NC, USA.
Matthew E
ME
Dupre
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Fernando
F
Morita
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Carolina
C
Pereira
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Fabio G M
FG
Franco
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Rogerio R
RR
Prado
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Antonio E
AE
Pesaro
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Mauricio
M
Wajngarten
D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D065186:Interrupted Time Series Analysis / Q000379:methods / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D010343:Patient Admission / Q000639:trends*; D012959:Socioeconomic Factors; D020521:Stroke / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D014478:Unemployment / Q000639:trends*
Myocardial infarction; Stroke; Unemployment