A recent study finds a significant link between unemployment and greater risk of cancer by linking global economic crisis is with unemployment and reduced public expenditure on health care (PEH). Researchers explored the links of changes in unemployment and PEH on cancer and determined how universal health coverage (UHC) affected these relationships. The researchers used data collected by the World Health Organization (WHO) over two decades, from 1990-2010, the results of which were published online on May 25, 2016.

The researchers investigated cancers that had a high survival rate, specifically prostate cancer in men, breast cancer in women and colorectal cancer in both genders. The survival rate for these types of cancer was more than 50%, so they were categorized under the treatable class. The researchers also studied pancreatic cancer and lung cancer, both of whose survival rates over five years, were less than 10%, hence causing them to be categorized under the untreatable class.

The data was collected and analyzed for country-specific demographics and infrastructure, with time-lag adjustments made to accurately and precisely determine the links between unemployment, public-sector expenditure on healthcare (PEH) and cancer rates with and without universal health coverage (UHC). It is to be noted that there was no source of funding for this study.

Data was available for 75 countries, representing 2.106 billion people, for the unemployment analysis while for the PEH analysis, data was available for 79 countries representing 2.156 billion people. Unemployment was found to be associated with a higher risk of all types of cancer except lung cancer in women. However, the untreatable cancer rate was not significantly linked to unemployment. For treatable cancers, the association remained even after five years of increasing unemployment.

After the analysis was done, the associations significantly decreased when UHC was taken into account. Moreover, all types of cancers significantly decreased when PEH increased. Over time, on the basis of 2000-2007 trends ,analysis showed that treatable cancers caused more than 40,000 deaths from 2008-2010. Most of these deaths were in countries where universal healthcare was lacking.

Hence, it was deduced that UHC seemed to curb higher death rates due to cancer under high unemployment. It is estimated that during the 2008 economic crisis, about 260,000 excess cancer-related deaths were reported in the Organization for Economic Co-operation and Development (OECD) alone.

Background

During the 2008 economic crisis many people lost their jobs due to rising unemployment, with public funding to healthcare sector being significantly reduced. Several studies have shown that such financial and economic changes greatly increase suicide rates, cardiovascular disease frequency and overall mortality. Economic crises lead to increased mortality rates as byproducts of stress-related issues.

Cancer is a leading cause of death worldwide, accounting for 82 million deaths in 2012, with estimates suggesting a rise in annual cancer cases from 14 million in 2012 to 22 million by 2030. Hence, researchers wanted to explore possible channels that could impact cancer worldwide. Furthermore, before this study, very few researches were done on the impact of economic and financial sectors on cancer rates, especially in underdeveloped countries where the national health system was quite sensitive to economic changes.

The most challenging part of the study was that it was associating health risks with economic instability, since most of the observable changes took 20-30 years to take place. Lifestyle-related cancer, suicide or acute stress-related cardiovascular events were all examples of such changes.

The researchers found that mortality was easier to study since it did not have as many variables as other incidences because its susceptibility of incidence values rose after the adoption of improved means of diagnosis.

Given the complex and intricate interlinking of socioeconomics, national health reforms and cancer growth rates, the study should affect how future health policies are developed and implemented.

Method Of Analysis

For the analysis, economic data was obtained from the World Bank’s Development Indicators & Global Development Finance 2013 datasets. Unemployment was defined as individuals seeking work but currently not employed. PEH was defined by the World Bank as rent and capital spending from the government, external grants from non-government agencies and social health insurance funds.

The researchers defined middle-income countries as those with a gross national income per person of more than US $1045 but less than $12,736, whereas high-income countries were those with a gross national income per person of $12,736 or more. Countries were classified into those with very high or high human development indices according to the UN’s Human Development Program.

The researchers took into account age-specific cancers and normalized the data to avoid discrepancies due to age-specific data. At the time the data was collected, complete cancer mortality data for China, India, and countries from sub-Saharan Africa was unavailable.

Multivariable regression analysis served as the response variable to assess the relation between mortality rates for each cancer subtype, treatable cancers, untreatable cancers, and all cancers while unemployment or PEH served as the predictor variable. This analysis model made the research authentic since it excluded factors such as genetic disposition to cancer and political and cultural factors that could produce anomalies in the data set. The presence of UHC further added robustness to the analysis, so the researchers reran the analysis process, keeping in mind the effects on the connection in the presence of UHC.

Data for 2010 was not included since the cancer mortality rate data for that year was incomplete.

To make sure that accurate data was recorded, countries with less than 90% registration were excluded, and individuals over the age of 85 were excluded due to comorbidity. To further ensure data robustness, all age groups that showed less than 20 deaths per annum were excluded.

Results

The results showed that increases in unemployment from 1990-2009 were associated with increased mortality from prostate, breast, lung (men), and colorectal cancers across a range of countries. Unemployment also increased mortality rate due to all cancers being both treatable and non-treatable. Time-lag analyses suggested that these adverse effects persisted after initial rises in unemployment. Most of these associations remained significant after accounting for economic, resource availability, infrastructure, and out-of-pocket spending indicators.

UHC implementation removed the association between changes in unemployment and cancer mortality, since it provided a policy of protection and safeguarding national health. Increased funding on public health sector also improved cancer rates.