Abstract
ObjectivesLittle is known about the gender and age differences associated with the effects of economic fluctuations on hospitalization for cardiovascular diseases. This paper investigates the impact of economic fluctuations on hospitalization for ischemic heart disease (IHD), stroke, and hypertension by age and gender between January 1996 and December 2012 in Taiwan.MethodsWe adopted a multiple-input time series analysis to examine the strength of the immediate and latent effects of the 17-year quarterly unemployment rates (UR), air pollution exposure (APE), gross domestic product (GDP), per capita consumption expenditure in cigarette and alcohol (ECA), and per capita healthcare expenditure (HE) on the adjusted quarterly incidence rate of hospitalization. The data used in this paper were retrieved from the National Health Insurance Research Database and the website of the Directorate-General of Budget, Accounting and Statistics (DGBAS), Executive Yuan.ResultsOur findings indicate that higher UR increased IHD hospitalization in young men and women and middle-aged women but reduced stroke hospitalization in young men. Higher APE increased IHD hospitalization in young men but reduced it for young women, increased stroke hospitalization in old men and middle-aged women but reduced it for young men, and increased hypertension hospitalization in middle-aged men and young women. Higher ECA reduced IHD hospitalization in middle-aged men, increased stoke hospitalization in middle-aged and old men and middle-aged women. Higher HE reduced IHD hospitalization in old men, young and old women, reduced stroke hospitalization in old women, and reduced hypertension hospitalization in young and middle-aged women.ConclusionsOverall, we found that the economic fluctuations caused increased harmful effects in certain population subgroups but also brought some soothing effects to some groups.
Highlights
Cardiovascular diseases (CVDs) account for approximately 31% of all global deaths [1], and various research studies have investigated the association between cardiovascular mortality and economic fluctuations
Our findings indicate that higher unemployment rates (UR) increased ischemic heart disease (IHD) hospitalization in young men and women and middle-aged women but reduced stroke hospitalization in young men
We found that the economic fluctuations caused increased harmful effects in certain population subgroups and brought some soothing effects to some groups
Summary
Cardiovascular diseases (CVDs) account for approximately 31% of all global deaths [1], and various research studies have investigated the association between cardiovascular mortality and economic fluctuations. Procyclical effects (where such an effect is defined as a decrease in the unemployment rate predicting an increase in mortality due to cardiovascular diseases and vice versa) were found in 23 OECD (Organization for Economic Cooperation and Development) countries [2], the USA [3,4,5,6], and 8 Asia-Pacific countries [7]. Countercyclical effects (where such an effect is defined as a decrease in the unemployment rate predicting a decrease in mortality due to CVDs and acute myocardial infarction and vice versa) were found in Sweden for those of prime working age, that is, between 20 and 49 years old [8], and in Greece [9]. No significant association was found in Iceland [15] or in Greece [16]
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