Economic Crises and Infectious Diseases Table 1. Cont. Country 27. United States 1980–1982 Years examined Study design Econo- metric study Measure of economic or political crisis Health Outcome Key Findings GNP decline from Upper- 8% suffered from upper-respiratory problems 20.4 to 21.7, respiratory ,7% suffered from genito-urinary infections unemployment problems, Tuberculosis rate increase increase from 7.1% genitor- Congenital syphilis rose 164% to 9.7%, increase in urinary Colorado state reported a 6% drop in the proportion Consumer Price Index infections, of fully immunized two year olds. from 88.7 to 288.6 TB, syphilis, The health status and risks for children appeared Immunization affected which was attributed to a combination of rates circumstances that included serious recession, increased poverty rates for households with children and diminished health benefits and social support services. High diarrheal disease rates were caused by drinking water contamination. Deterioration of water treatment and distribution systems resulted in cross-connections between drinking water lines and sewer. Decrease in population covered by chlorinated water system from 98% in 1988 to 26% in 1994. Mortality from diarrhoeal diseases rose from 2.7 per 100,000 persons in 1989 to 6.8 in 1993. Outbreak of Guillian Barre secondary to enteric infections in areas that lost chlorination. Rising incidence TB from 5.5 per 100,000 in 1990 to 15.3 in 1994. 48% increase in TB deaths between 1992 and 1993. 67% increase in infectious and parasitic diseases deaths (8.3 to 13.9 per 100,000)between 1989 and 2003 77% increase in deaths due to influenza and pneumonia (23.0 to 40.7 percent) between 1989 and 2003 Increase in ID proportional mortality in 1989 from 8.3 per 100,000 to 13.4 in 1995. Rates of morbidity due to respiratory diseases, acute diarrhoeal diseases, STIs, infectious neuro, TB (5.1 per 100,000 in 1990 increased to 14.1 in 1995), leptospirosis Rise in diarrhoea, hepatitis A and venereal diseases Communicable disease mortality rates increased in the 1994–96 period by 5–6%. 1.5% of the population infected with cholera in 1991, Paxson; World Bank increases in malaria cases between 1989–1996, measles Economic Review 2005; epidemic 1992 (263 deaths). However unlikely to 19(2): 203–223 account for high infant mortality during this period, due to lack of magnitude and timing. Statistically significant effect of war and sanctions (WAS) on mortality due to infectious diseases in men aged 15–24 and 25–34 yrs. Overall male and female mortality from infectious diseases was significantly higher on the basis of the trend for the preceding period. Source Miller 1984 World Development Report Semenza et al., Am J. Trop. Hyg 1996;59(6)941–946. Garfield R, Santana S. American Journal of Public Health 1997;87(1):15–20. Ochoa Int J Health Services 1997; 27(4): 791–807 Kuntz 1994 Int J Health Serv. Cutler et al Journal of Public Economics 2002, 84: 279–303 Vlajinac 1997 J Epidemiol Community Health Djordjevic J Parasitology 2003; 89(2): 226 Reintjes; Emerging Infectious Diseases, 2002, 8: 69–73 Parkhurst 2004 Soc Sci Med 59:1913–24 Trichinellosis Rise in trichinellosis incidence Tularemia Outbreak of tularaemia pharyngitis (327 cases) HIV Increase in HIV prevalence in South Africa 28. Uzbekistan 1996 29. Cuba 1980–1996 Randomized Period of economic, trial political, and social transition Diarrheal diseases Descriptive Period of economic Infectious analysis decline; U.S. Embargo diseases 30. Cuba 1989–1995 Descriptive Period of economic analysis decline Infectious diseases 31. Cuba 1989–1993 32. Mexico 1994–1995 33. Peru 1978–1996 34. Serbia 1992–1995 35. Serbia 2001–2002 36. Serbia, Kosovo 1999–2000 37. South Africa 1994 doi:10.1371/journal.pone.0020724.t001 Descriptive Period of economic analysis decline Multivariate GDP growth rate regression Descriptive Peru economic crash Malaria, analysis in late 1980s- GPD fell measles, by 30%, real wages cholera fell by 80% Diarrhoea, hepatitis A, venereal diseases Commu- nicable Diseases Infectious diseases Descriptive UN Economic analysis sanctions, Loss of trade, 31% drop in income Descriptive War in former analysis Yugoslavia Descriptive Period following analysis military conflict Descriptive Period of transition analysis to democracy PLoS ONE | www.plosone.org 7 June 2011 | Volume 6 | Issue 6 | e20724