Elsevier

Social Science & Medicine

Volume 66, Issue 8, April 2008, Pages 1699-1708
Social Science & Medicine

Economic development as a determinant of injury mortality – A longitudinal approach

https://doi.org/10.1016/j.socscimed.2007.12.020Get rights and content

Abstract

Cross-sectional studies have produced clear inverted U-shaped curves between injury mortality and economic development; yet, this does not mean that single countries will necessarily follow similar curves as they grow richer over time. This study was conducted to examine whether previous cross-sectional findings can be verified using a longitudinal approach. Data for both injury mortality and gross domestic product (GDP) per capita were obtained from an official health database for the member countries of the Organization for Economic Cooperation and Development (OECD) for the period of 1960–1999. Regression models were then used to examine the longitudinal relationship between these two variables. Substantial improvements in injury mortality were observed in all income categories in the selected countries. For higher and middle high-income countries, injury mortality rates (all causes) increased until 1972, peaking in 1972 and then declining. For industrialized countries with relatively low GDP, injury mortality rates increased until 1977 and then declined. Using cubic regression lines for injury mortality rates, for all income categories, injury mortality rates increased up to a GDP per capita of $3000–$4000, then decreased significantly. The rising trends of suicide and homicide rates were observed until countries attained a GDP per capita of around $13,000–$14,000 for all income categories. It is noteworthy that compared to the intentional injury categories, mortality due to road traffic accidents and injuries from falls declined earlier on in the economic development process. Longitudinal analysis among high-income countries confirms earlier cross-sectional findings; that is, most injury categories seem to follow inverted U-shaped trend lines, with declining trends after peaking at various stages of temporal and economical development. A comparison between time and economy suggests that differences in peaking time between countries for the same injury category is partly a reflection of temporal differences in economic development.

Introduction

Economic development has long been considered an important determinant of changing patterns of disease, disability, and mortality in populations (McKeowan et al., 1975, Preston, 1975, Preston, 1978, Rogers and Wofford, 1989). Throughout the last century, important epidemiological changes accompanied economic development in most countries, especially those known today as high-income countries (HICs). Further, both mortality and fertility rates declined enormously. Rising standards of living in a population make a major contribution to the shift in main causes of death, from infectious and communicable diseases such as malaria, diarrhea, and tuberculosis to non-communicable and man-made conditions such as cancers, cardiovascular diseases, and injuries resulting from road traffic accidents (van Beeck et al., 1998, Murray and Chen, 1993, Murray and Lopez, 1997, Oppe, 1991, Thom et al., 1985). These major changes in disease patterns led to the formulation of a theory called the ‘health (epidemiologic) transition’ theory (Omran, 1971). This ‘health transition’ may have been completed in all high-income countries, whereas in developing countries it is still underway (Omran, 1971, Omran, 1983).

In high-income countries, the rising trends in cardiovascular diseases of the 1950s and 1960s were later reversed in spite of growing economic development (Uemura & Pisa, 1988). In the 1970s, such observations inspired the graphic modeling of the health transition process in the form of ‘waves’ of health problems replacing each other through the course of historical development: first a declining wave of communicable diseases (diseases of poverty), to be followed by a wave of non-communicable diseases (diseases of civilization or well-being), and thirdly (and tentatively) an upswing in psycho-social health problems (Hjort, 1994).

Discerning secular trends and understanding health transition processes are essential for the adoption of adequate health policies and health planning in all countries. The relationship between socio-economic development and injury as a cause of mortality and morbidity needs further clarification (Beaglehole & Bonita, 2004). In an attempt to examine the relationship between economic development and injury mortality, cross-sectional studies have produced diverging results. Early studies on road traffic injury in a global perspective showed increasing injury mortality rates with growing national economies (Söderlund and Zwi, 1995, Wintemute, 1985). However, more recent and comprehensive studies on unintentional injury mortality (UIM) in the span from low to high-income countries have yielded more complex findings. These analyses have consistently shown an inverted U-shaped pattern in relation to economic development (Ahmed and Andersson, 2000, Ahmed and Andersson, 2002, Moniruzzaman and Andersson, 2005a, Plitponkarnpim et al., 1999, Plitponkarnpim et al., 1999). In parallel cross-sectional studies on intentional injury mortality (suicide and homicide), similar inverted U-shaped patterns are also found in association with GNP per capita (Moniruzzaman and Andersson, 2004, Moniruzzaman and Andersson, 2005b).

The main problem in previous cross-sectional studies where the association between injury mortality and economic development was examined is that even if cross-sectional studies produce clear inverted U-shaped curves for mortality from low to high-income countries at a specific point of time, this does not necessarily mean that specific countries follow similar curves as they grow richer over time. This is why further analysis is required to examine whether previous cross-sectional findings can be verified using a longitudinal approach.

Since high-income countries have generally advanced through most stages of epidemiological transition, as far is known today, this paper aims to explore the longitudinal relationship between injury mortality and economic development in high-income countries over a long time span.

Section snippets

Data sources and inclusion criteria

Mortality and GDP per capita – US$ adjusted with purchasing power parity (PPP) data – were derived from the official health database for the member countries of the Organization for Economic Cooperation and Development (OECD) for the period of 1960–1999 (OECD, 2006). PPP-adjusted values are the rates of currency conversion that equalize the purchasing power of different currencies. Thus, PPP-adjusted values eliminate differences in price levels between countries. Data for all OECD countries

Results

Injury mortality (all causes) and cause-specific injury mortality (i.e., RTA, fall injury, suicide, and homicide) rates over time, for the three income categories of countries, are shown in Fig. 2. In recent decades, substantial improvements in injury mortality have been observed in all income categories. More specifically, for income categories 1 and 2, injury mortality rates (all causes) first increased up until 1972, with rates of mortality peaking in 1972 – at 73 per 100,000 population –

Discussion

Data from 21 member countries of the OECD were analyzed in this study. These countries are referred to as the ‘established market economies’ (Murray & Lopez, 1997) or the ‘industrialized countries’ (Söderlund & Zwi, 1995). There were two major shifts of countries between the income categories since 1960; New Zealand's GDP per capita was similar to that of Australia, Canada, and Denmark (category 1) in 1960 and Ireland's GDP per capita was close to the average for category 3 (Greece, Portugal,

Conclusion

Longitudinal analyses among high-income countries confirm earlier cross-sectional findings, where most injury categories seem to follow inverted U-shaped trend lines, with declining trends after peaking at various stages of temporal and economic development. Injury mortality rates increased up to a certain level of GDP per capita in all income country categories, and then decreased significantly up to the highest level of GDP per capita. The comparison of injury mortality between time and

Acknowledgements

We wish to thank Karen Leander for English checking and the Swedish Rescue Services Agency, for their financial support.

References (43)

  • D. Stern et al.

    Is there an environmental Kuznets curve for sulfur?

    Journal of Environmental Economics and Management

    (2001)
  • G.J. Wintemute

    Is motor vehicle-related mortality a disease of development?

    Accident Analysis & Prevention

    (1985)
  • E.B. Barbier

    Introduction to the environmental Kuznets curve

    Environment and Development Economics

    (1997)
  • R. Beaglehole et al.

    Public health at the crossroads. Achievements and prospects

    (2004)
  • E.F. van Beeck et al.

    Economic development and traffic accident mortality in the industrialized world, 1962–1990

    International Journal Epidemiology

    (2000)
  • E.F. van Beeck et al.

    Mortality due to unintentional injuries in the Netherlands, 1950–1995

    Public Health Reports

    (1998)
  • L.R. Berger et al.

    A global view of injury control

    (1996)
  • A.B. Bergman et al.

    Sweden's experience in reducing childhood injuries

    Pediatrics

    (1991)
  • D.J. Deeg et al.

    Health-profiles and profile-specific health expectancies of older women and men: the Netherlands

    Women Ageing

    (2002)
  • N.L. Farberow

    Suicide in different cultures

    (1975)
  • G.M. Grossman et al.

    Economic growth and the environment

    Quarterly Journal of Economics

    (1995)
  • Cited by (43)

    • Socioeconomic and environmental contexts of suicidal rates in a latitudinal gradient: Understanding interactions to inform public health interventions

      2022, Journal of Psychiatric Research
      Citation Excerpt :

      At local, country or similar spatial scales, several studies have reported a positive association between poverty and suicide rates (Iemmi et al., 2016; Hsu et al., 2019; but see Bando et al., 2012), although the effect size varies depending on sex. In contrast, on a regional or global scale, some studies have shown a marginally positive trend between income (or some proxy of it) and suicide rates (Moniruzzaman and Andersson, 2008; Noh, 2009). In the case of drug consumption, several studies have shown a link between drug use (marijuana, inhalants, etc.) and suicide attempts, especially among adolescents or young people (Hahm et al., 2013; Carvalho et al., 2019).

    • Mortality due to road injuries in the states of India: the Global Burden of Disease Study 1990–2017

      2020, The Lancet Public Health
      Citation Excerpt :

      Our findings, on the one hand, highlight the need to understand this relationship better, and on the other hand, indicate the urgent need for India and its states to improve investments in road safety in line with rising GDP to address the increasing number of deaths due to road injury.1,7 With the per-capita GDP being an important determinant of per-capita vehicles,22,23,51 the government need to invest in public transport systems that reduce individual motorcycle and car usage in India.52 Towards this aim, some Indian cities are at varying stages of implementing the Bus Rapid Transport Projects,53 but barriers to successful implementation of such projects need to be addressed effectively, including gaining acceptance from the community, in particular from those who do not use public transport.54,55

    • Suicides in Greece before and during the period of austerity by sex and age group: Relationship to unemployment and economic variables

      2020, Journal of Affective Disorders
      Citation Excerpt :

      Our results are in accord with this. However the relationship of GDP with suicide-related behaviors seems to be more complex and it might follow an inverted U-shaped curve, with suicide trends declining after peaking at a certain threshold of economic development (Moniruzzaman and Andersson, 2008). At low GDP levels, increases in GDP are associated with increases in suicide rates, but once a given threshold of economic development is reached, further increases in GDP do not correlate with further increases in suicide rates (Voracek, 2009).

    • Reducing road traffic deaths: where should we focus global health initiatives?

      2018, Journal of Surgical Research
      Citation Excerpt :

      For example, being an HIC was the only other factor associated with fewer RTIs. This finding is in accordance with previous literature that showed higher economic status was associated with reduced RTD rates.23,30,31 Decreased RTDs after economic growth may be secondary to structural changes such as improved road quality or a shift from two-wheel vehicles (i.e., bikes or motorcycles) to four-wheel vehicles (i.e., cars).30

    • Prediction of mortality risk in victims of violent crimes

      2017, Forensic Science International
      Citation Excerpt :

      Due to the circumstances, physical injuries are often complicated not only by severe disability but also long-standing mental health problems [3]. While a downward trend in homicide rates since 1990 has been reported [4] there is a general notion of increased brutality in violent crimes over the same time period and reports of increased incidence of violent crimes [5]. One explanation for this apparent paradox is the potential impact by changes over time in treatment success after severe injury [6].

    View all citing articles on Scopus
    View full text