Is there a link between cardiovascular mortality and economic fluctuations?

Abstract

Background: Unemployment might affect several risk factors of cardiovascular disease (CVD), which is the leading cause of death globally. The characterisation of the relation between these two phenomena is thus of great significance from a public-health perspective. The main aim of this study was to estimate the association between the unemployment rate and mortality from CVD and from coronary heart disease (CHD). Additional aims were (a) to assess whether the associations are modified by the degree of unemployment protection; (b) to determine the impact of GDP on heart-disease mortality; and (c) to assess the impact of the Great Recession in this context. Methods: We used time-series data for 32 countries spanning the period 1960–2015. We applied two alternative modelling strategies: (a) error correction modelling, provided that the data were co-integrated; and (b) first-difference modelling in the absence of co-integration. Separate models were estimated for each of five welfare state regimes with different levels of unemployment protection. We also performed country-specific ARIMA-analyses. Results: Because the data did not prove to be co-integrated, we applied first-difference modelling. The estimated effect of unemployment and GDP on CVD as well as CHD was statistically insignificant across age and sex groups and across the various welfare state regimes. An interaction term capturing the possible excess effect of unemployment during the Great Recession was also statistically insignificant. Conclusions: Our findings, based on data from predominantly affluent countries, suggest that heart-disease mortality does not respond to economic fluctuations.