Department of Global Health and Population, Harvard University, Boston, MA, USA.
J Epidemiol Community Health. 2012 May;66(5):410-9. doi: 10.1136/jech.2010.121376. Epub 2011 Mar 24.
Previous research suggests that the Great Depression led to improvements in public health. However, these studies rely on highly aggregated national data (using fewer than 25 data points) and potentially biased measures of the Great Depression. The authors assess the effects of the Great Depression using city-level estimates of US mortality and an underlying measure of economic crisis, bank suspensions, at the state level.
Cause-specific mortalities covering 114 US cities in 36 states between 1929 and 1937 were regressed against bank suspensions and income data from the Federal Deposit Insurance Corporation Database, using dynamic fixed-effects models and adjustments for potential confounding variables.
Reductions in all-cause mortalities were mainly attributable to declines in death rates owing to pneumonia (26.4% of total), flu (13.1% of total) and respiratory tuberculosis (11.2% of total), while death rates increased from heart disease (19.4% of total), cancer (8.1% of total) and diabetes (2.9%). Only heart disease can plausibly relate to the contemporaneous economic shocks. The authors found that a higher rate of bank suspensions was significantly associated with higher suicide rates (β=0.32, 95% CI 0.24 to 0.41) but lower death rates from motor-vehicle accidents (β=-0.18, 95% CI -0.29 to -0.07); no significant effects were observed for 30 other causes of death or with a time lag.
In contrast with existing research, the authors find that many of the changes in deaths from different causes during the Great Depression were unrelated to economic shocks. Further research is needed to understand the causes of the marked variations in mortality change across cities and states, including the effects of the New Deal and Prohibition.
先前的研究表明,大萧条改善了公共卫生状况。然而,这些研究依赖于高度聚合的国家数据(使用的数据集少于 25 个)和可能存在偏差的大萧条衡量指标。作者使用城市层面的美国死亡率数据和州层面的经济危机指标(银行停业数)来评估大萧条的影响。
作者使用动态固定效应模型,对 1929 年至 1937 年间美国 36 个州的 114 个城市的死因死亡率进行回归分析,将其与银行停业数和联邦存款保险公司数据库中的收入数据进行回归分析,并对潜在的混杂变量进行了调整。
全因死亡率的下降主要归因于肺炎(占总死亡率的 26.4%)、流感(占总死亡率的 13.1%)和呼吸性结核病(占总死亡率的 11.2%)死亡率的下降,而心脏病(占总死亡率的 19.4%)、癌症(占总死亡率的 8.1%)和糖尿病(占总死亡率的 2.9%)死亡率则有所上升。只有心脏病可能与同期的经济冲击有关。作者发现,银行停业率较高与自杀率上升显著相关(β=0.32,95%置信区间为 0.24 至 0.41),而与机动车事故死亡率下降显著相关(β=-0.18,95%置信区间为-0.29 至-0.07);其他 30 种死因或存在时间滞后的死因与银行停业率无显著相关性。
与现有研究相反,作者发现大萧条期间许多不同死因死亡率的变化与经济冲击无关。需要进一步研究来了解死亡率在不同城市和州之间的显著变化的原因,包括新政和禁酒令的影响。