Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Social and Cardiovascular Epidemiology Research Group, Universidad de Alcala, Madrid, Spain.
Int J Epidemiol. 2017 Aug 1;46(4):1147-1156. doi: 10.1093/ije/dyx016.
In the 20th century, periods of macroeconomic growth have been associated with increases in population mortality. Factors that cause or mitigate this association are not well understood. Evidence suggests that social policy may buffer the deleterious impact of economic growth. We sought to explore associations between changing unemployment (as a proxy for economic change) and trends in mortality over 30 years in the context of varying social protection expenditures.
We model change in all-cause mortality in 21 OECD (Organization for Economic Cooperation and Development) countries from 1980 to 2010. Data from the Comparative Welfare States Data Set and the WHO Mortality Database were used. A decrease in the unemployment rate was used as a proxy for economic growth and age-adjusted mortality rates as the outcome. Social protection expenditure was measured as percentage of gross domestic product expended.
A 1% decrease in unemployment (i.e. the proxy for economic growth) was associated with a 0.24% increase in the overall mortality rate (95% confidence interval: 0.07;0.42) in countries with no changes in social protection. Reductions in social protection expenditure strengthened this association between unemployment and mortality. The magnitude of the association was diminished over time.
Our results are consistent with the hypothesis that social protection policies that accompany economic growth can mitigate its potential deleterious effects on health. Further research should identify specific policies that are most effective.
在 20 世纪，经济增长时期与人口死亡率的上升有关。导致或减轻这种关联的因素尚未得到很好的理解。有证据表明，社会政策可能会缓冲经济增长的不利影响。我们试图探讨在不同社会保护支出的情况下，失业（作为经济变化的代理指标）变化与 30 年来死亡率趋势之间的关联。
我们构建了 21 个经合组织（经济合作与发展组织）国家从 1980 年到 2010 年全因死亡率变化的模型。使用了来自比较福利国家数据集和世卫组织死亡率数据库的数据。失业率的下降被用作经济增长的代理指标，年龄调整后的死亡率作为结果。社会保护支出以国内生产总值的百分比衡量。
在没有社会保护变化的国家中，失业率（即经济增长的代理指标）下降 1%与总死亡率上升 0.24%（95%置信区间：0.07；0.42）相关。社会保护支出的减少加强了失业与死亡率之间的这种关联。这种关联的幅度随着时间的推移而减弱。
我们的结果与以下假设一致，即伴随经济增长的社会保护政策可以减轻其对健康的潜在不利影响。进一步的研究应该确定最有效的具体政策。
