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PubMed1998

Economic evaluation of health promotion: friend or foe?

It is commonly believed that economic evaluation is hostile to health promotion and that the requirement for health programs to be cost effective will result in a biased allocation of funds in favour of programs that can demonstrate short-run benefits as defined by inadequate outcome measures. The paper is concerned with the validity of this perception. It is argued that economic evaluation has the potential for treating health promotion activities on an equal basis with other health interventions. The major obstacle to this does not arise from the theory of economic evaluation, which is discussed, but from a lack of information about outcomes. Without this information any evaluation--economic or otherwise--is flawed. Three problems relating to the economic evaluation of health promotion activities are considered. These are: the discounting of future health benefits; the potential for economic evaluation to be counter-productive if applied to 'immature' projects; and the practical problems encountered in the measurement of the outcomes of health promotion programs. A four-fold classification which is based upon a distinction between disease cure, individual health promotion, community welfare and systemic change designed to promote either individual health or social well-being. The capacity of economics to incorporate these objectives is discussed.

Cost-Benefit Analysis↗
PubMed2000

Trends in coronary heart disease--has the socio-economic differential changed?

OBJECTIVE: To compare both trends in rates of coronary heart disease and levels of coronary risk factors between different socio-economic groups. METHODS: Rates of coronary events for men and women aged 25 to 69 years were estimated from a population-based register in the Lower Hunter Region of New South Wales from 1985 to 1993. Risk factor levels were estimated for men and women aged 35 to 64 years from three surveys of risk factors conducted in 1983, 1988/89 and 1994 in the same study population. RESULTS: There was a decline in major coronary events from 1985 to 1993. The greatest decline was for fatal coronary events, which fell by between 4.3% and 9.1% per year. Trends in event rates were similar for all socio-economic groups, except for trends in non-fatal definite myocardial infarction among women. Women from the areas with high socio-economic status tended to have a greater reduction in non-fatal definite myocardial infarction compared with women from low socio-economic areas. Trends in risk-factor levels were similar except the prevalence of cigarette smoking among women from the lowest quintile of socio-economic status did not decline. CONCLUSION: Prevention strategies seem to have had a beneficial impact on this population, resulting in similar declines in rates of coronary events for all socio-economic groups. However, event rates are still high, suggesting a further reduction in mortality and morbidity is possible. This could be achieved by further reductions in smoking, cholesterol and blood pressure, especially among people from areas with low socio-economic status.

Adult↗
PubMed1990

The impact of economic hardship on black families and children: psychological distress, parenting, and socioemotional development.

Family processes affecting the socioemotional functioning of children living in poor families and families experiencing economic decline are reviewed. Black children are of primary interest in the article because they experience disproportionate shares of the burden of poverty and economic loss and are at substantially higher risk than white children of experiencing attendant socioemotional problems. It is argued that (a) poverty and economic loss diminish the capacity for supportive, consistent, and involved parenting and render parents more vulnerable to the debilitating effects of negative life events, (b) a major mediator of the link between economic hardship and parenting behavior is psychological distress deriving from an excess of negative life events, undesirable chronic conditions, and the absence and disruption of marital bonds, (c) economic hardship adversely affects children's socioemotional functioning in part through its impact on the parent's behavior toward the child, and (d) father-child relations under conditions of economic hardship depend on the quality of relations between the mother and father. The extent to which psychological distress is a source of race differences in parenting behavior is considered. Finally, attention is given to the mechanisms by which parents' social networks reduce emotional strain, lessen the tendency toward punitive, coercive, and inconsistent parenting behavior, and, in turn, foster positive socioemotional development in economically deprived children.

Affective Symptoms↗
PubMed2005

Socio-economic position across the life course and hysterectomy in three British cohorts: a cross-cohort comparative study.

OBJECTIVE: To examine the association between indicators of lifetime socio-economic position and rates of hysterectomy in three British cohorts. DESIGN: Cross-cohort comparative study. SETTING: Two cohorts: England, Scotland and Wales. Third cohort: Aberdeen, Scotland. POPULATION: Three thousand two hundred and eight women born between 1919 and 1940, participating in the British Women's Heart and Health Study (BWHHS); 1394 women from the MRC National Survey of Health and Development (NSHD), followed up since birth in 1946; 3208 women born between 1950 and 1955, participating in the Aberdeen Children of the 1950s study, all with complete information on lifetime socio-economic position and hysterectomy status. METHODS: Relative indices of inequality were derived for markers of socio-economic position in childhood and adulthood. Cox's regression models were used to test the association between these markers and hysterectomy. MAIN OUTCOME MEASURE: Self-reported hysterectomy with or without oophorectomy. RESULTS: Adverse socio-economic position in childhood and as indicated by educational status was associated with reduced rates of hysterectomy in the oldest of the three cohorts (BWHHS), whereas conversely in the NSHD and Aberdeen cohorts it was associated with increased rates of hysterectomy. The unadjusted hazards ratios for hysterectomy comparing worst to best socio-economic position for father's social class were 0.73 (0.56, 0.96) for women from the BWHHS, 1.77 (1.19, 2.65) for those from the NSHD and 2.06 (1.46, 2.89) for those from the Aberdeen cohort. Associations between markers of adult socio-economic position and hysterectomy tended to be weaker in all three cohorts and often did not reach conventional levels of statistical significance. CONCLUSIONS: Our results show that hysterectomy rates are influenced by childhood socio-economic position and educational attainment, but that the nature of this association varies across these three British cohorts born in different decades of the 20th century. That there were no consistent or strong associations between adult SEP and hysterectomy rates suggest that social factors influencing rates of hysterectomy are likely to be those experienced or which develop in early life rather than those which develop later.

Adult↗
PubMed2001

Economic evaluation in stroke research. An introduction.

BACKGROUND AND PURPOSE: Before developing new medical facilities or adapting existing facilities in the field of stroke, it is desirable to assess not only the medical, but also the economic consequences of such facilities. Economic evaluation studies differ from other outcome studies in the way that costs are compared with effects. The purpose of this paper is to give an insight into economic evaluation studies in the field of stroke, so that these studies become easier for neurologists to understand and to apply. SUMMARY OF THE ARTICLE: Crucial aspects in economic evaluation research are addressed successively, such as the techniques used and how the results can be influenced by the perspective of the study. The article also considers the inclusion of costs and consequences in economic evaluation research. At the end of this article, special issues in economic evaluation studies are presented such as discounting, sensitivity analysis, incremental analyses and ratios. CONCLUSIONS: Although neurologists have no direct responsibility for allocating scarce resources in the field of stroke, they are confronted with the results of these decisions in their everyday work. Because of this, it might be useful to have clear understanding of economic evaluation studies and their caveats.

Costs and Cost Analysis↗
PubMed2003

The economics of Alzheimer disease.

Economic assessments of health and healthcare have become an integral part of policy decisions in the last decade. Increasingly, this trend is extending to medical decision-making in day-to-day patient-provider interactions. Alzheimer disease (AD) offers a potent example of the clinical and economic issues at stake with its diagnostic techniques, pharmacotherapies, and public health and policy implications. This review introduces basic economic concepts in examining the impact of AD and related care. It presents a summary of the latest economics research on cost estimates of AD and on economic evaluations of diagnostic and management interventions in terms of cost-of-illness and cost-effectiveness studies respectively. Empirical and conceptual issues about the interpretation of costs and the uses of evaluative methods are also discussed. We found that the economic costs attributable to AD care is highly variable mostly due to non-standardised methodologies and geographical variations in care patterns. There is, however, little doubt that the impact is substantial and is expected to worsen with the demographic, epidemiologic, technologic and economic transitions worldwide. There are comparatively fewer studies on the cost-effectiveness of interventions in AD. Most of the published work revolves around pharmacotherapeutics while relatively little has been done on diagnostics, patient care programmes and programmes for caregivers. We conclude that there are significant opportunities to strengthen research on standardised cost-of-illness analyses and new cost-effectiveness studies on a broader range of AD interventions.

Alzheimer Disease↗
PubMed1997

Inspired oxygen concentrations with or without an oxygen economizer during ether draw-over anaesthesia.

An oxygen economizer tube is attached to draw-over vaporizers and acts as a reservoir of supplemental oxygen. The clinical importance of the presence or absence of the economizer tube (volume 130 ml) has not been adequately studied in manually ventilated patients using ether from an Ohmeda Cyprane Portable Anesthesia Complete (PAC) draw-over vaporizer. A total of sixteen patients ASA 1-2, undergoing elective surgery for peripheral orthopaedic procedures were studied with and without an economizer tube. Each patient acted as his or her own control. Standard procedures were used for anaesthetic induction with muscle relaxant, endotracheal intubation and anaesthetic maintenance. Supplemental oxygen was supplied by an oxygen concentrator. Using the draw-over vaporizer without an oxygen economizer tube, there was a slight increase in FiO2 of 20%, 23%, 27%, 30%, 33% and 33%, with increasing oxygen supplementation of 0 to 5 l/min, respectively. With an economizer tube, the FiO2 values increased to 20%, 26%, 35%, 46%, 54% and 66% at 0 to 5 l/min of oxygen respectively. The FiO2 values were significantly different at 3, 4, and 5 l/min (P < 0.05), showing the potential advantages of an oxygen economizer tube attached to a draw-over vaporizer in this setting. No significant differences were seen in the oxygen saturations of these healthy patients with or without an oxygen economizer.

Adult↗
PubMed2005

Do economic stresses influence child work hours on family farms?

BACKGROUND: Economic stresses are a frequently cited reason for children doing farm work. OBJECTIVE: To explore the relationship between economic indicators and child agricultural work hours between January 2001 and October 2003. METHODS: This ecologic study design compares trends in aggregate child work hours with national and regional economic indicators. Child work hours were obtained from quarterly surveillance data from a randomized field trial of agricultural task guidelines for children. 2,360 children living or working on 845 farms in central New York participated in the original study. The relationship between child work hours and three economic indicators: national all farm index (AFI) ratio, national fuel index, and regional milk prices was analyzed using times series plots, correlation, and multiple linear regression. RESULTS: The AFI ratio was positively correlated with child work hours (r = 0.49, p = 0.008) but there was no significant correlation between child work hours and fuel or milk prices. Multiple linear regression demonstrated that the relationship between AFI and child work hours is independent of a seasonal effect. CONCLUSIONS: Increased child work hours may be associated with periods of higher farm sector productivity, rather than economic stress per se. Findings are limited by the ecologic study design, use of national economic indicators, and the limited number of cycles of child work hours available for time series analysis. Economic conditions may influence decisions about children's farm work.

Accidents, Occupational↗
PubMed1996

Economic evaluation of vaccination.

With increasing expenditures in healthcare, in absolute terms as well as in relative terms, interest in the efficiency of certain interventions in healthcare has also increased. Faced with the limitations of the healthcare budget, budget holders try to find the optimal way of dividing their funds over different healthcare provisions, without discarding human and medical considerations. In economic terms, this process could be called the 'optimal allocation of scarce resources over the inputs of a function of production'. The means of production would then be 'the provision of healthcare', whereas the output would be 'improvement of health'. Clearly choices have to be made with regard to spending the healthcare budget. One of the instruments that can help in making such choices is the economic evaluation. In economic evaluations of vaccinations, different vaccination strategies are defined. The consequences in terms of costs and effects of each strategy are being calculated and compared with a reference strategy, which is often the nonintervention strategy, i.e. 'no vaccination'. According to the way in which the benefit or the output of vaccination-'improvement of health'-is measured, a distinction is made between various methods of economic evaluation: in a cost-effectiveness analysis, health gains are measured in natural units (e.g. prevented infections, prevented illness days, life-years gained, etc.); in a cost-utility analysis, the quality of the health gains is taken into account (e.g. quality-adjusted life-year); and in a cost-benefit analysis, health gains are converted into monetary units. Costs can be divided into direct and indirect costs. Direct costs are directly related to medical treatments (medication, laboratory tests, consultations, etc.) or to vaccination (e.g. purchasing price of the vaccine, costs for administering the vaccine, treatment of side effects, etc.). Costs indirectly related to treatments and vaccination are mainly costs of lost productivity due to disease morbidity or mortality, and opportunity costs. In comparison with other vaccine-preventable infections, influenza vaccination for the elderly seems acceptable from an economic point of view (about $US650 per life-year gained, in 1981). Cost-effectiveness ratios of other vaccinations range from about $US720 per life-year gained for universal hepatitis B vaccination to about $US190,000 per life-year gained for universal Haemophilus influenzae type by vaccination. Because of differences in methods, the representation of results, and country-specific parameters, different economic evaluations of the same vaccination strategy may show divergent results. Therefore, until sufficient standardisation of economic evaluations exists, comparisons of the sort we are making here should be interpreted with prudence.

Cost-Benefit Analysis↗
PubMed2001

Using economic evaluations to reduce the burden of asthma and chronic obstructive pulmonary disease.

There is increasing interest in the use of economic evaluations in healthcare, because of the need to maximise health benefits from limited resources. The focus of most economic evaluations is on efficiency, though they may also consider the issue of equity. In an economic evaluation, it is important to consider all the relevant costs, not just the acquisition cost of the treatment. Likewise, it is important to include all the benefits in the economic appraisal, although the outcomes of relevance to decision-makers may differ according to their perspective. If an intervention costs less but delivers fewer benefits than the comparator or, more commonly, a new intervention increases benefits compared with standard therapy but at increased cost, decision-makers must consider whether the extra cost is worth the extra benefit. This depends on the opportunity cost of introducing the new intervention - i.e. the benefit forgone by doing less of something else to fund it. In other words, decision-makers need to decide on the maximum amount they are willing to pay for an additional unit of health benefit. The result of an economic evaluation will be strongly influenced by the information used in the analysis. Currently, clinical trials are the most common source of data for economic evaluations. Yet there are a number of limitations in the information generated by clinical trials, which are primarily designed for regulatory approval. Consequently, decision analytical models are being increasingly used to synthesise data from various sources and to manage uncertainty in input parameters. When using economic evaluations, decision-makers may be unwilling to take a broad perspective on costs, focusing instead on their narrow budgetary concerns. Incentives may be required within healthcare systems to ensure that decision-makers adhere more strictly to the results of formal analysis.

Asthma↗
PubMed2003

Cystic fibrosis: cost of illness and considerations for the economic evaluation of potential therapies.

Cystic fibrosis (CF) is the most common life-shortening inherited disease of the Caucasian race, with a prevalence of around 1 in 2500 live births. Advances in the treatment and management of respiratory and pancreatic disorders have dramatically increased the life expectancy of patients with CF. This article presents an overview of cost-of-illness studies of CF, identifies deficits in the available health economic analyses of CF and discusses which specific factors are essential for the economic evaluation of potential therapies, based on a critical review of the health economic literature on two main therapeutic strategies. Cost-of-illness studies of CF have predominantly been restricted to direct costs. According to the literature, direct costs amount to between 6200- 16300 US dollars (1996 values) per patient per year. As most studies likely underestimated the actual costs (e.g. by disregarding provision of certain healthcare services), real healthcare costs tend to be at the upper end of the cost range. Healthcare costs depend on the patient's age (for adults, costs are approximately twice as high as for children), the grade of severity (the cost relationship of severe to mild CF is between 4.5 and 7.1) and other factors. Lifetime direct costs of CF are estimated at 200 000-300000 US dollars (at 1996 values and a discount rate of 5%). Home intravenous (IV) antibacterial therapy and recombinant human DNase (rhDNase; dornase alfa) treatment are the two main therapeutic strategies most often evaluated in health economic studies of CF. While home IV antibacterial therapy (compared with inpatient IV antibacterial therapy) is assumed to be cost saving, rhDNase treatment is a very cost-intensive therapy intended to efficiently achieve health improvements. Health economic analyses of future CF therapeutic technologies should present explicit data regarding healthcare services provision, resource consumption and unit costs. Indirect costs and patient costs should be considered more often than they have to date, particularly when they are significantly influenced by novel CF technologies. The perspective of health economic studies should be stated explicitly and always include the societal perspective. More economic studies should be based on a controlled, and preferably randomised, design. The observation period must be long enough to identify long-term effects of interventions. A greater number of effectiveness studies should be performed to determine costs and outcomes of therapies applied under everyday life conditions for patients with CF. Finally, international comparison studies should identify the influence of different healthcare systems on the costs and outcomes of interventions.

Anti-Infective Agents↗
PubMed2004

Health economic evaluation of non-melanoma skin cancer and actinic keratosis.

Non-melanoma skin cancer (NMSC) and actinic keratosis are becoming an increasingly important healthcare problem. There are approximately 1 million cases of NMSC in the US each year, primarily basal cell carcinomas, and the incidence is increasing. Although NMSC is significant in terms of both health risk and the resource implications for treatment within healthcare systems, our understanding of the health economics of NMSC is limited. The purpose of this article was to systematically review and assess published health economic studies of the treatment of NMSC and actinic keratosis, taking into consideration key aspects of guidelines set by drug purchasers and key reimbursement agencies, and to provide recommendations for appropriate modelling approaches and data collection for health economic studies of NMSC and actinic keratosis. We systematically reviewed the published literature from 1965 to 2003 for health economic evaluations of treatments of NMSC and actinic keratosis using the search terms: ('skin cancer' or 'non melanoma skin cancer' or 'basal cell carcinoma' or 'actinic keratosis') and ('decision model' or 'decision theoretic' or 'decision analytic' or 'health economic' or 'cost effective'). Studies using one of the following methodologies were included: cost-effectiveness, cost-benefit, cost-utility, cost-minimisation, cost-of-illness, cost-consequence, and treatment cost analysis. We identified eight studies evaluating NMSC. One of these studies also evaluated actinic keratosis. Although several studies satisfied some of the basic requirements of health economic evaluations, the majority had serious shortcomings that limit their usefulness. There are a few high-quality health economic evaluations assessing treatments for NMSC or actinic keratosis. However, our analysis suggests that additional data on treatment practice patterns and epidemiology need to be collected, and incorporated with efficacy and safety data in a formal decision-analytic framework to assist decision makers in allocating scarce healthcare resources.

Clinical Trials as Topic↗
PubMed2004

Economic aspects of pneumococcal pneumonia: a review of the literature.

In this review, the economic aspects of pneumococcal pneumonia are analysed, including the costs, cost effectiveness and cost benefit of treatment and prevention. We identified eight cost-of-illness studies, 15 analyses comparing the costs of different treatment options and 15 economic evaluations of prevention that met our search criteria. The studies were conducted largely in Europe and the US. Most pertained to community-acquired pneumonia (CAP) in general, without specific analysis of pneumococcus-related illness. Many of the studies were considered to be of poor quality for the following reasons: comparison without randomisation or control variables, disregard of health outcomes, small sample size, restriction of costs to drug costs and vague or disputable sources of cost information. In the US, hospitalisation costs resulting from CAP can be estimated to be between US 7,000 dollars and US 8,000 dollars per admission or US 4 million dollars per 100,000 population. Hospitalisation costs are significant (representing about 90% of total costs), but are much lower in Europe than in the US (one-third to one-ninth of the US estimates in the UK and Spain, respectively). In general, economic studies of treatment for pneumococcal pneumonia are in line with clinical evidence. A drug with proven clinical effectiveness would also appear to be supported from an economic stand point. Furthermore, economic data support an early switch from an intravenous to an oral antibacterial, the use of quinolones for inpatients with CAP, and also the use of guidelines built on clinical evidence. Of all the possible preventive strategies for pneumococcal pneumonia, only vaccination has been subjected to economic evaluation. Pneumococcal polysaccharide vaccine seems relatively cost effective (and potentially cost saving) for those between 65 and 75 years of age, for military recruits and for HIV positive patients with a sufficiently high CD4 cell count. Evaluations of the pneumococcal conjugate vaccine (PCV) indicate the price of the vaccine to be the main determinant of cost effectiveness. As the current price is high (in the order of US 50 dollars per dose), the economic attractiveness of the universal PCV vaccination strategies hinges on the potential for price reductions and the willingness of decision makers to adopt a societal perspective.

Administration, Oral↗
PubMed2005

Assessing the annual economic burden of preventing and treating anogenital human papillomavirus-related disease in the US: analytic framework and review of the literature.

The anogenital human papillomavirus (HPV) is estimated to be the most commonly occurring sexually transmitted infection in the US. Comprehensive estimates of the annual economic burden associated with the prevention and treatment of anogenital HPV-related disease in the US population are currently unavailable. The purpose of this paper is to (i) outline an analytic framework from which to estimate the annual economic burden of preventing and treating anogenital HPV-related disease in the US; (ii) review available US literature concerning the annual economic burden of HPV; and (iii) highlight gaps in current knowledge where further study is particularly warranted. Among eight US studies identified that describe the annual economic burden pertaining to one or more aspects of anogenital HPV-related disease, three met the review eligibility criteria (published between 1990 and 2004, examined multiple facets of annual anogenital HPV-related economic burden, and clearly articulated the data and methods used in the estimation process). All costs were adjusted to 2004 US dollars. Estimates of the annual direct medical costs associated with cervical cancer were comparable across studies (range 300-400 million US dollars). In contrast, there was a wide range across studies for estimates of the annual direct medical costs associated with cervical intraepithelial neoplasia (range 700 million US dollars-2.3 billion US dollars). Only one study reported direct medical costs for anogenital warts (200 million US dollars) and routine cervical cancer screening (2.3 billion US dollars). No studies examined direct medical costs attributable to HPV-related anal, penile, vaginal or vulvar cancers, or the work and productivity losses resulting from time spent receiving medical care, morbidity or mortality. Current economic burden estimates would suggest annual direct medical costs associated with the prevention and treatment of anogenital warts and cervical HPV-related disease of at least 4 billion US dollars. This figure would likely rise to at least 5 billion US dollars per year if direct medical costs associated with other disease entities caused by the sexual transmission of HPV were included, with further additions to the economic burden totalling in the billions of dollars if work and productivity losses were incorporated, a research priority for future studies.

Costs and Cost Analysis↗
PubMed2001

Economic growth, income equality, and population health among the Asian Tigers.

The "Tiger" economies of Southeast Asia provide examples of developing nations where economic growth and increasing income equality are compatible and, when occurring together, are associated with superior health trends over time. The degree of income inequality in the Asian Tigers declined during the period of rapid economic growth. Traditionally, economists have viewed economic growth and relative parity in income distribution as incompatible, or trade-offs. This poses a public policy dilemma, since a reasonable propensity to increase a nation's overall economic well-being would mean forsaking measures that increase income parity. The Asian Tigers, however, have shown that this need not be viewed as a trade-off. Economic growth and a simultaneous increase in income equality are possible and, with respect to health outcomes, desirable. The authors propose a variety of mechanisms through which income inequality can enhance economic growth, and discuss policies in education, agricultural land reform, and housing that influence the simultaneous attainment of income equality and economic growth.

Asia, Southeastern↗
PubMed1989

Genetic and economic responses to breeding programs that consider mastitis.

Eight breeding programs were evaluated with a simulation study using discounted gene flow. Discounted economic responses and annual genetic changes were calculated. The evaluation was over 25 periods of 13 mo and the population modeled was DHI cows served by AI sires in the US. A breeding program without regard for mastitis gave annual genetic increases of 53.5 kg milk, 2.24 kg fat, .020 cases of mastitis, and an economic response of $98.24. Including SCC or mastitis in selection indexes that maximize economic gain reduced the rate of improvement in yield traits by 1 to 2% but did not reduce clinical mastitis. Instead these indexes slowed the rate of increase in clinical mastitis by 20 to 25% and increased response in economic merit by less than 1%. Restricted selection, which permitted no genetic change in mastitis, reduced the rates of improvement by up to 27% for yield and 17% for economic response. Direct selection against mastitis is unrealistic due to lack of field data on clinical mastitis. Indirect selection would be less efficient than predicted here, due in part to incomplete enrollment in SCC testing program. Simultaneous improvement of both yield and mastitis apparently is not economically desirable due to the antagonistic genetic correlation between yield and mastitis and to the relatively greater economic value and higher heritability of yield.

Analysis of Variance↗
PubMedDate not supplied

The economic burden of malaria.

Malaria and poverty are intimately connected. Controlling for factors such as tropical location, colonial history, and geographical isolation, countries with intensive malaria had income levels in 1995 of only 33% that of countries without malaria, whether or not the countries were in Africa. The high levels of malaria in poor countries are not mainly a consequence of poverty. Malaria is geographically specific. The ecological conditions that support the more efficient malaria mosquito vectors primarily determine the distribution and intensity of the disease. Intensive efforts to eliminate malaria in the most severely affected tropical countries have been largely ineffective. Countries that have eliminated malaria in the past half century have all been either subtropical or islands. These countries' economic growth in the 5 years after eliminating malaria has usually been substantially higher than growth in the neighboring countries. Cross-country regressions for the 1965-1990 period confirm the relationship between malaria and economic growth. Taking into account initial poverty, economic policy, tropical location, and life expectancy, among other factors, countries with intensive malaria grew 1.3% less per person per year, and a 10% reduction in malaria was associated with 0.3% higher growth. Controlling for many other tropical diseases does not change the correlation of malaria with economic growth, and these diseases are not themselves significantly negatively correlated with economic growth. A second independent measure of malaria has a slightly higher correlation with economic growth in the 1980-1996 period. We speculate about the mechanisms that could cause malaria to have such a large impact on the economy, such as foreign investment and economic networks within the country.

Cost of Illness↗
PubMed1975

Variation of caries frequency with socio-economic background in unselected and extreme groups of 14-year old children in Malmö.

The purpose of the present investigation was to find out whether any correlation exists between socio-economic factors and caries frequency in unselected and extreme groups of 14-year old school children in Malmö. The material consisted of 360 randomly selected 14-year old school children in Malmö (1969) and their parents. The number of DF-surfaces was obtained from the records of the school dental service. Data on the parents' occupation and gross incomes in 1969 were obtained from the tax office in Amlmö. Extreme groups were obtained by chosen those 10% with the highest caries frequency (H'-group) and a corresponding group with the lowest frequency of caries (L'-group). These two subgroups were compared with a selection of 14-year old school children with high (H-group) and low (L-group) caries frequency, which have been analysed earlier in respect of socio-economic background. No significant correlation was found between socio-economic factors and caries frequency in the non-stratified selection. H'-group and L'-group, on the other hand, showed marked differences in socio-economic background. Compared with the H-group, the H'-group showed a higher number of DF-surfaces. This difference was due to variations in distribution of caries between different schools but was not clearly correlated to socio-economic factors. The differences in socio-economic distribution between H'-group and H-group like between L'-group and L-group were not found to be significant. The findings mean that the conclusions drawn regarding socio-economic factors and dental care regarding H- and L-group also can be regarded as representative of schoolchildren with extremely high and low caries frequency, respectively.

Adolescent↗