Aims: It is unclear how economic factors impact on the epidemiology of infectious disease. We evaluated the relationship between incidence of selected infectious diseases and economic factors, including economic downturn, in 13 European countries between 1970 and 2010. Methods: Data were obtained from national communicable disease surveillance centres. Negative binomial forms of the generalised additive model (GAM) and the generalised linear model were tested to see which best reflected transmission dynamics of: diphtheria, pertussis, measles, meningococcal disease, hepatitis B, gonorrhoea, syphilis, hepatitis A and salmonella. Economic indicators were gross domestic product per capita (GDPpc), unemployment rates and (economic) downturn. Results: GAM models produced the best goodness-of-fit results. The relationship between GDPpc and disease incidence was often non-linear. Strength and directions of association between population age, tertiary education levels, GDPpc and unemployment were disease dependent. Overdispersion for almost all diseases validated the assumption of a negative binomial relationship. Downturns were not independently linked to disease incidence. Conclusions: Social and economic factors can be correlated with many infections. However, the trend is not always in the same direction, and these associations are often non-linear. Economic downturn or recessions as indicators of increased disease risk may be better replaced by GDPpc or unemployment measures.
Bibliographical noteFunding Information:
The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, the Department of Health or Public Health England. We thank our meticulous but anonymous reviewers. This study was part funded by the European Centre for Disease Control and Prevention. P.H., J.B. and F.J.C.-G. were also supported by the National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response led by Kings College London in partnership with Public Health England.
© Author(s) 2019.
- hepatitis B
- meningococcal disease