Understanding the Conflicting Effects Of Business Cycles on Influenza Vaccines and Severity

Abstract

It is well established that recessions affect individuals’ health and health behaviors through a variety of pathways. Recently, research has demonstrated that these effects are heterogeneous and often widen health disparities. Literature investigating the effect of business cycles on disease transmission is limited. The seasonal influenza provides a unique opportunity to analyze these effects due to its annual recurrence, high transmissivity, and relatively low risk of death. Studies investigating the effect of local employment rates on the seasonal influenza have focused on either vaccination uptake or influenza activity in isolation. This study bridges this gap using state-level vaccination and influenza activity level estimates reported by the Centers for Disease Control from 2009-2017. I employ a standard Ordinary Least Squares as well as a two-stage model to investigate the effect of state-level unemployment rate on these outcomes. I compare these outcomes and find that increasing unemployment rate is significantly associated with decreased vaccination uptake in all groups, especially working-age adults and black populations. I find increases in health insurance coverage during these years due mitigate this effect. I find no response in influenza severity associated with increased unemployment rate, demonstrating that decreasing contact rates may mitigate the observed decreases in vaccination rates in determining influenza outbreak severity. Further, I provide evidence that children drive seasonal influenza outbreaks and that children’s vaccination rates are associated with higher influenza-like-activity.