142nd APHA Annual Meeting and Exposition

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Impact of the Great Recession on Heart Disease Mortality in US States and European Countries: A Geo-Spatial Analysis

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 9:10 AM - 9:30 AM

Harvey Brenner, Ph.D. , School of Public Health, University of N. Texas Health Science Center, Department of Behavioral and Community Health & Bloomberg School of Public Health Johns Hopkins University, Fort Worth, TX

This study determines the extent to which the global recession of 2008 has had a harmful influence on heart disease mortality rates among US States and European Union (EU) countries.


Data on the extent of the recession are given by national income per capita (GDP pc) and the unemployment rate in US States and EU countries. Heart disease mortality is the outcome variable. Control variables for the US include health insurance coverage, smoking prevalence, alcohol consumption, body mass index (BMI) and percent of population African-American. For the EU, controls include smoking prevalence, alcohol consumption, BMI. US economic data are from the Departments of Commerce and Labor; demographic and health-related data and heart disease mortality are from the NCHS. EU economic data are from EUROSTAT, while health-related data and heart disease mortality are from the WHO European region.

Statistical Methods:

Using geo-spatial analysis, age-standardized heart disease mortality among the US States and EU countries are predicted by GDP pc and unemployment rates for US States and EU countries respectively with controls for the variables listed under “DATA” (above). Pooled cross-sectional time-series linear regression analysis estimates these relations over 2000 – 2010.


For both US States and EU countries, GDP pc is inversely, and unemployment is positively, related to age-adjusted heart disease mortality (US model R squared .75; EU R squared .60). Recessional and control variables for both countries were significant at p < .0001.


Decreased income per capita and high unemployment rates served to increase heart disease mortality rates in the US and Europe. Targeted economic policies involving the social safety net, unemployment payments and retraining and health insurance are crucial to the health of US and European populations.

Learning Areas:

Biostatistics, economics
Chronic disease management and prevention
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Assess the impact of the Great Recession of 2008 on heart disease Compare the United States and Europe in terms of the impact of unemployment on heart disease mortality Analyze whether changes in socioeconomic status have a greater impact on cardiovascular health in the United States as compared to Europe Identify the types of policies suited to mitigating the impact of lost income and higher unemployment on health

Keyword(s): Heart Disease, Low-Income

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator of several grants and contracts dealing with the impact of economic growth and unemployment on health and on cardiovascular illness in particular. Funding agencies have included the National Institutes of Health, the Department of Labor, the European Union and the World Health Organization.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5047.0: Geo-Spatial Epidemiology