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

Paul Hunter, Felipe De Jesus Colon Gonzalez, Julii Brainard, Batsirai Majuru, Debora Pedrazzoli, Ibrahim Abubakar, Girmaye Dinsa, Marc Suhrcke, David Stuckler, Tek-Ang Lim, Jan C. Semenza

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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.

Original languageEnglish
Pages (from-to)351-361
Number of pages11
JournalScandinavian Journal of Public Health
Issue number4
Early online date10 Jul 2019
Publication statusPublished - 1 Jun 2020


  • Gonorrhoea
  • Hepatititus B
  • Measles
  • Menningococcal disease
  • Pertussis
  • Salmonella
  • Europe
  • Surveillance
  • GDP

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