Maruthappu Mahiben, Da Zhou Charlie, Williams Callum, Zeltner Thomas, Atun Rifat
Imperial College London, London, UK ; Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA.
New College, University of Oxford, Oxford, UK.
J Glob Health. 2015 Jun;5(1):010403. doi: 10.7189/jogh.05.010403.
The global economic downturn has been associated with increased unemployment and reduced public-sector expenditure on health care (PSEH). We determined the association between unemployment, PSEH and HIV mortality.
Data were obtained from the World Bank and the World Health Organisation (1981-2009). Multivariate regression analysis was implemented, controlling for country-specific demographics and infrastructure. Time-lag analyses and robustness-checks were performed.
Data were available for 74 countries (unemployment analysis) and 75 countries (PSEH analysis), equating to 2.19 billion and 2.22 billion people, respectively, as of 2009. A 1% increase in unemployment was associated with a significant increase in HIV mortality (men: 0.1861, 95% CI: 0.0977 to 0.2744, P = 0.0000, women: 0.0383, 95% CI: 0.0108 to 0.0657, P = 0.0064). A 1% increase in PSEH was associated with a significant decrease in HIV mortality (men: -0.5015, 95% CI: -0.7432 to -0.2598, P = 0.0001; women: -0.1562, 95% CI: -0.2404 to -0.0720, P = 0.0003). Time-lag analysis showed that significant changes in HIV mortality continued for up to 5 years following variations in both unemployment and PSEH.
Unemployment increases were associated with significant HIV mortality increases. PSEH increases were associated with reduced HIV mortality. The facilitation of access-to-care for the unemployed and policy interventions which aim to protect PSEH could contribute to improved HIV outcomes.
全球经济衰退与失业率上升以及公共部门医疗保健支出（PSEH）减少有关。我们确定了失业率、公共部门医疗保健支出与艾滋病毒死亡率之间的关联。
数据来自世界银行和世界卫生组织（1981 - 2009年）。实施了多变量回归分析，并对特定国家的人口统计学和基础设施进行了控制。进行了时间滞后分析和稳健性检验。
有74个国家的数据可用于失业率分析，75个国家的数据可用于公共部门医疗保健支出分析，截至2009年，分别相当于21.9亿人和22.2亿人。失业率每上升1%，艾滋病毒死亡率显著上升（男性：0.1861，95%置信区间：0.0977至0.2744，P = 0.0000；女性：0.0383，95%置信区间：0.0108至0.0657，P = 0.0064）。公共部门医疗保健支出每增加1%，艾滋病毒死亡率显著下降（男性： - 0.5015，95%置信区间： - 0.7432至 - 0.2598，P = 0.0001；女性： - 0.1562，95%置信区间： - 0.2404至 - 0.0720，P = 0.0003）。时间滞后分析表明，在失业率和公共部门医疗保健支出发生变化后，艾滋病毒死亡率的显著变化持续长达5年。
失业率上升与艾滋病毒死亡率显著上升相关。公共部门医疗保健支出增加与艾滋病毒死亡率降低相关。为失业者提供就医便利以及旨在保护公共部门医疗保健支出的政策干预措施可能有助于改善艾滋病毒防治结果。
