Economic Crises and Infectious Diseases Table 1. Summary of literature on the relationship between economic and political crisis and communicable diseases. Study design Measure of economic or political crisis Descriptive Period of economic, analysis political, and social transition Descriptive Period of economic, analysis political, and social transition TB and HIV incidence rate Health Outcome Key Findings Infectious Declining trend in mortality from infectious and parasitic diseases in Croatia. Stable mortality due to disease ID in Central and Eastern European countries mortality (50% above EU average) Country 1. Central and Eastern Europe 2. Central and Eastern Europe 3. Central and Eastern Europe 4. Central and Eastern European countries 5. Central and Eastern Europe 6. Centrally Independent States (former Soviet Union) Years examined 1987–1994 1991–1998 1989–1991 1989–1999 1990s 1993–4 7. Croatia, East 1991–1995 8. Czech and Slovak Republic 1993–2002 10. Eastern European and former Soviet Union 11. Estonia 12. Central and Eastern European countries (n = 15) 13. European Union countries (26) 1992–2002 1987–1990 and 1999– 2000 1980–2006 1970–2007 14. Germany 1980–2000 9. Eastern Europe 1990–1992 and former Soviet Union Descriptive Period of economic, analysis political, and social transition Source Hofmarcher, Croatian Medical Journal1998; 39(3): 241–8 Migliori, Monaldi Arch Chest Dis 2002; 57(5–6): 285–90 Sumilo Reviews in medical virology 2008; 18: 81–95 Coker et al Lancet 2004; 363(9418): 1389–1392. Randolph 2007; Microbes and Infection, 10: 209–216. Vitek and Wharton; Emerging Infectious Diseases, 1998, (4): 539–550 Aberle et al. Pediatrics International 2007;49(2):183–9. Gulis BMJ 2005; 331: 213–5 Raviglione Tubercle and Lung Disease 1994; 75: 400–16 Stuckler D, King LP, Basu S. PLoS Med 2008;5(7):e143. Stuckler et al. Lancet 2009; 374 (9686): 315023 Multivariate State unemployment Pneumonia 1% rise in unemployment rate associated with 3.65% Neumayer; Social regression rate and influenza decrease in mortality rate in males, 3.07% decline in Science & Medicine both sexes (non-significant for females) in static model. 2004; 58(6): 1037–47 In dynamic model, only significant decline (1.38%) in females. Three times stronger effect in over-65 s. PLoS ONE | www.plosone.org 5 June 2011 | Volume 6 | Issue 6 | e20724 Descriptive GNP analysis Descriptive Period of economic, analysis political, and social transition Descriptive Period of economic, analysis political, and social transition Descriptive Period of economic, analysis political, and social transition Descriptive Period of military analysis conflict Descriptive Period of economic, analysis political, and social transition Tick-borne encephalitis TB Tick-bone encephalitis (TBE) Diphtheria TB TB Increase in incidence of notified TB (34 to 82.1 in Russian Federation, 49.2 to 122.9 in Kyrgyzstan, 55.8 to 114 in Romania, 36.4 to 81.7 in Lithuania) Increase in incidence of HIV infection in IDUs (50–90% increase) in Belarus, Kazakhstan, Moldova, Russian Federation, Ukraine). Increase in syphilis cases from 3000 to 80,000 in Ukraine High prevalence of MDR-TB (10.7% Estonia, 9% Latvia, 9% Ivanovo, 6.5% Tomsk Oblasts) High incidence of TB in prisons Lower GNP associated with higher TBE incidence Incidence of TB tripled in Russia in decade after 1991: 34 to 92 per 100,000 persons Increase in incidence of TBE in early 1990s, not seen in neighbouring countries Surge in diphtheria cases to highest incidence of 50,425 in 1995. 1989–90 70% increase in diphtheria cases in Soviet Union 1992–93 290% increase in Russia alone. Epidemic diphtheria reported from all states except Estonia Increase in incidence of childhood TB from rates in 1991 of 4.3 (0–4 years age), 7.6 (5–9 years age), 2.9 (10–14 years age), 23.3 (15–19 years age) to 6.3, 7.6, 12.7, 12.4 respectively in 2003. Salmonellosis Increase in salmonellosis cases per 100,000 between 1993 and 2002 from 220.09 to 398.28 in Slovak Republic and 417.65 to 476.4 in Czech Republic Steady increase in TB mortality in Romania, Armenia, Kyrgystan, Latvia, Lithuania, Moldova, Turmenistan Multivariate Change in GDP, years Tuberculosis IMF program participation was associated with regression of an International increases in tuberculosis incidence, prevalence, Monetary Fund and mortality by 13.9%, 13.3%, and 16.6%. programme, dummy Decrease in tuberculosis mortality rates of 30.7% for IMF lending associated with exiting the IMF programs. programme, size of IMF loan, urbanization Descriptive Period of economic, analysis political, and social transition Infectious diseases mortality Multivariate regression Multivariate 1% increase in regression unemployment Mass unemploy- ment (.3% rise) Age- standardised TB Mortality Rate Ethnic difference seen between Estonians and Russians- Leinsalu J Epi Comm greater increase in deaths due to Health 2004; 58:583–89 infectious diseases (and all other causes of death) than ethnic Estonians Excess TB Strong linear association between GDP decline Arinaminpathy/Dye cases and TB over the period of recession and excess TB Journal of the Royal mortality cases (r2 = 0.94, p.0.001) and deaths (r2 = 0.94, p,0.001)Society 2010; 7(52): 1559–69 No significant effects