Unexpected decline in tuberculosis cases coincident with economic recession - United States, 2009

BACKGROUND

Since 1953, through the cooperation of state and local health departments, the U.S. Centers for Disease Control and Prevention (CDC) has collected information on incident cases of tuberculosis (TB) disease in the United States. In 2009, TB case rates declined -11.4%, compared to an average annual -3.8% decline since 2000. The unexpectedly large decline raised concerns that TB cases may have gone unreported. To address the unexpected decline, we examined trends from multiple sources on TB treatment initiation, medication sales, and laboratory and genotyping data on culture-positive TB.

METHODS

We analyzed 142,174 incident TB cases reported to the U. S. National Tuberculosis Surveillance System (NTSS) during January 1, 2000-December 31, 2009; TB control program data from 59 public health reporting areas; self-reported data from 50 CDC-funded public health laboratories; monthly electronic prescription claims for new TB therapy prescriptions; and complete genotyping results available for NTSS cases. Accounting for prior trends using regression and time-series analyses, we calculated the deviation between observed and expected TB cases in 2009 according to patient and clinical characteristics, and assessed at what point in time the deviation occurred.

RESULTS

The overall deviation in TB cases in 2009 was -7.9%, with -994 fewer cases reported than expected (P < .001). We ruled out evidence of surveillance underreporting since declines were seen in states that used new software for case reporting in 2009 as well as states that did not, and we found no cases unreported to CDC in our examination of over 5400 individual line-listed reports in 11 areas. TB cases decreased substantially among both foreign-born and U.S.-born persons. The unexpected decline began in late 2008 or early 2009, and may have begun to reverse in late 2009. The decline was greater in terms of case counts among foreign-born than U.S.-born persons; among the foreign-born, the declines were greatest in terms of percentage deviation from expected among persons who had been in the United States less than 2 years. Among U.S.-born persons, the declines in percentage deviation from expected were greatest among homeless persons and substance users. Independent information systems (NTSS, TB prescription claims, and public health laboratories) reported similar patterns of declines. Genotyping data did not suggest sudden decreases in recent transmission.

CONCLUSIONS

Our assessments show that the decline in reported TB was not an artifact of changes in surveillance methods; rather, similar declines were found through multiple data sources. While the steady decline of TB cases before 2009 suggests ongoing improvement in TB control, we were not able to identify any substantial change in TB control activities or TB transmission that would account for the abrupt decline in 2009. It is possible that other multiple causes coincident with economic recession in the United States, including decreased immigration and delayed access to medical care, could be related to TB declines. Our findings underscore important needs in addressing health disparities as we move towards TB elimination in the United States.

Taking a beating. Healthcare execs see stock holdings, company portfolios nosedive

The pounding that healthcare companies have taken on Wall Street is getting personal for their CEOs, whose holdings at their respective companies are down more than $180 million in value this year. "The key driver of incentives is stock holding. That's where the action is," says Wayne Guay, left, of the Wharton School. Boards may want to consider increasing their CEOs' relative weighting to equity compensation, he says.

Entropies of negative incomes, Pareto-distributed loss, and financial crises

Health monitoring of world economy is an important issue, especially in a time of profound economic difficulty world-wide. The most important aspect of health monitoring is to accurately predict economic downturns. To gain insights into how economic crises develop, we present two metrics, positive and negative income entropy and distribution analysis, to analyze the collective “spatial” and temporal dynamics of companies in nine sectors of the world economy over a 19 year period from 1990–2008. These metrics provide accurate predictive skill with a very low false-positive rate in predicting downturns. The new metrics also provide evidence of phase transition-like behavior prior to the onset of recessions. Such a transition occurs when negative pretax incomes prior to or during economic recessions transition from a thin-tailed exponential distribution to the higher entropy Pareto distribution, and develop even heavier tails than those of the positive pretax incomes. These features propagate from the crisis initiating sector of the economy to other sectors.

Recessions are bad for workplace safety

Workplace accidents are an important economic phenomenon. Yet, the pro-cyclical fluctuations in workplace accidents are not well understood. They could be related to fluctuations in effort and working hours, but workplace accidents may also be affected by reporting behavior. Our paper uses unique data on workplace accidents from an Austrian matched worker-firm dataset to study in detail how economic incentives affect workplace accidents. We find that workers who reported an accident in a particular period of time are more likely to be fired later on. And, we find support for the idea that recessions influence the reporting of moderate workplace accidents: if workers think the probability of dismissals at the firm level is high, they are less likely to report a moderate workplace accident.

This recession is wearing me out! Health-related quality of life and economic downturns

BACKGROUND

Health-related quality of life refers to an individual's perceived physical and mental health and goes beyond the presence or absence of illnesses to encompass a multidimensional concept of well being. Previous research on the relationships between macroeconomic conditions and health status reveal improvements in physical health during economic downturns. However, few studies have examined whether mental health status improves or declines during tough economic times.

AIMS

The main objective of this paper is to provide new evidence on the impact of macroeconomic conditions on Health-related quality of life (HRQL), or functional health, by analyzing the physical and mental health summary scores of the 12-Item Short Form Health Survey (SF-12).

DATA

The analysis uses panel data from Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) for individuals 18-59 years (in Wave 1), for a final sample of 26,313 individuals. The NESARC collected and reported data on the SF-12 health scores, including a physical health score (PCS) for overall physical functioning, and a mental health score (MCS) for mental/psychological functioning. To analyze the impact of economic downturns on HRQL, the study matches the NESARC variables with data on state-level macroeconomic conditions.

METHODS

To estimate the effects of macroeconomic conditions on HRQL, this paper takes advantage of the longitudinal nature of the dataset and uses individual fixed-effect models to account for both individual and state-level heterogeneity. Although it is unlikely for individual omitted variables (e.g., individuals' preferences and attitudes) to be significantly correlated with the state unemployment rate, using longitudinal data allows for the estimation of a more fully specified model.

RESULTS

Findings consistently indicate that an increase in the average state unemployment rate worsens an individual's HRQL, suggesting that the loss of jobs and income and/or the economic distress associated with economic downturns have a detrimental effect on people's daily lives. Although the magnitudes of the changes are generally small, results show that mental health decreases more than physical health during tough economic times.

POLICY IMPLICATIONS

With the recent worldwide economic recession causing steep drops in the U.S. Gross Domestic Product along with double-digit unemployment rates, the implications of this study are disheartening. Besides macroeconomic policies to help stimulate the economy, government officials and policymakers should also consider social policies to help people cope with the recession and buffer the potential negative health impact, both mental and physical. Moreover, policymakers should keep in mind that the mental health effects might be greater and longer lasting.

Impact of the global economic crisis on metal levels in particulate matter (PM) at an urban area in the Cantabria Region (Northern Spain)

Air pollution by particulate matter is well linked with anthropogenic activities; the global economic crisis that broke out in the last year may be a proper indicator of this close relationship. Some economic indicators show the regional effects of the crisis on the Cantabria Region. The present work aims to evaluate the impact of the economic crisis on PM10 levels and composition at the major city of the region, Santander. Some metals linked to anthropogenic activities were measured at Santander and studied by Positive Matrix Factorization; this statistical analysis allowed to identify three main factors: urban background, industrial and molybdenum-related factor. The main results show that the temporal trend of the levels of the industrial tracers found in the present study are well agree with the evolution of the studied economic indicators; nevertheless, the urban background tracers and PM10 concentration levels are not well correlated with the studied economic indicators.

[Financial crisis and mental health in Greece]

Several studies indicate an association between economic crises and psychological burden. To investigate the possible impact of the current economic crisis on mental health in Greece, the association between two economic indicators (unemployment and average income) and mental health variables (psychiatric clinic admittance, visits to outpatients' departments and emergency units, suicides, homicides, mortality rates and divorces) was studied. The data were gathered by the Greek Statistical Service and some others were provided by the following hospitals: Eginition Hospital, Psychiatric Hospital of Attica, Athens General Hospital and Evaggelismos Hospital. Simple and multiple regression analyses were performed on the data. There was no significant correlation between the level of unemployment, as well as the average income, and admittance to the psychiatric clinics. A significant correlation was isolated between unemployment and visits to outpatients' department (R2 = 0.40, p = 0.001) and emergency unit (R2 = 0.49, p = 0.0002) of Eginition Hospital. The unemployment rate during the period 1981-2008 was positively associated with the number of homicides (R2 = 0.16, beta = 0.000049, p = 0.03), as well as the number of divorces (R2 = 0.20, beta = 0.005, p = 0.02) during the same period. The average income showed positive association with the visits to both outpatients' department (R2 = 0.55, p < 0.001) and emergency unit (R2 = 0,37, p = 0.004) of Eginition Hospital. However, the data from the 4 hospitals of the study revealed a negative correlation between average income and visits to outpatients' departments (R2 = 0.70, p = 0.02) and emergency units (R2 = 0.90, p < 0.001). Furthermore, a significant negative correlation between the average income and suicide rates (R2 = 0.37, p = 0.007), as well as a positive correlation between the average income and divorce rates (R2 = 0.73, p < 0.001) were found. The findings show several similarities with previous surveys in countries with analogous economic crises, such as the Former Eastern Bloc countries, Asian countries and the USA. Future studies, at a more late stage of the economic crisis, are expected to reveal more reliable associations with mental health. Finally, these findings are expected to inform intervention programmes dealing with prevention or mitigation of the impact of economic crisis on citizens' mental health.

Fertility changes in Latin America in periods of economic uncertainty

We explored the relation between fertility and the business cycle in Latin America. First, we used aggregate data on fertility rates and economic performance for 18 countries. We then studied these same associations in the transitions to first, second, and third births with DHS individual data for ten countries. The results show that in general, childbearing declined during economic downturns. The decline was mainly associated with increasing unemployment rather than slowdowns in the growth of gross domestic product, although there was a positive relationship between first-birth rates and growth. While periods of unemployment may be a good time to have children because opportunity costs are lower, in fact childbearing was reduced or postponed, especially among the most recent cohorts and among urban and more educated women. The finding is consistent with the contention that, during this particular period in Latin America, income effects were dominant.

Mapping dental establishments in New York State just before the recession

Census Bureau data indicate a continuing increase in the number and size of dental establishments in the period just prior the recent recession. During this same period, the combination of a relatively limited increase of the population in New York State and increasing numbers of dentists and dental establishments resulted in decreases in population ratios, particularly in New York City. The usual favorable expectations of an economic upswing after a recession for dental establishments may need to be tempered given these developments.