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Can economic indicators predict infectious disease spread? A cross-country panel analysis of 13 European countries

Research output: Contribution to journalArticle


  • Paul R. Hunter
  • Felipe J. Colón-González
  • Julii Brainard
  • Batsirai Majuru
  • Debora Pedrazzoli
  • Ibrahim Abubakar
  • Girmaye Dinsa
  • Marc Suhrcke
  • David Stuckler
  • Tek Ang Lim
  • Jan C. Semenza


Publication details

JournalScandinavian journal of public health
DateAccepted/In press - 30 Apr 2019
DateE-pub ahead of print (current) - 10 Jul 2019
Number of pages1
Early online date10/07/19
Original languageEnglish


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.

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© Author(s) 2019.This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

    Research areas

  • Gonorrhoea, hepatitis B, measles, meningococcal disease, pertussis, salmonella

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