Impacts of regional unemployment variation on preventive health behavior: The case of flu vaccination

Previous studies examined the impact of labor market conditions on health outcomes and behavior such as physical exercises, smoking, hospital visits, obesity, heart attack, depression, suicide, and general health status. Recently, two studies found a significant relationship between economic recessions and the spread of seasonal flu. Despite this large volume of studies on macroeconomic conditions and health, there is limited research on the mechanism behind these relationships.

This study explores the effect of the macroeconomic environment measured by local labor market conditions on seasonal flu vaccination, thus not only contributing to the literature on the impact of economic factors on individual health behavior, but also providing insights on its influence over individual decisions on seeking preventive care. The 2008-2012 individual-level data from the Behavioral Risk Factor Surveillance System (BRFSS) were merged with the Area Health Resources Files (AHRF), and the Bureau of Labor Statistics Local Area Unemployment Statistics (LAUS).  

To examine the relationship between local unemployment rates and individual flu vaccination, multivariate probit models were estimated for the entire sample, and for sub-samples of racial/ethnic groups, different employment status and county types. After controlling for individual socioeconomic and demographic factors and contextual characteristics, a one percentage point increase in a county’s unemployment rate during the month of interview was associated with an 1.11, 1.01, 0.99, 1.59, and 1.08 percentage point decrease of a person’s vaccination probability for the entire sample, and the samples for non-Hispanic white, non-Hispanic black, non-Hispanic Asian and Hispanic respectively. The decrease was 1.10%, 0.85%, and 0.78% in metropolitan counties, urban but non-metropolitan counties, and rural counties respectively. For every one percentage point rise in unemployment rates, vaccination probability decreased by 1.28, 0.77, 1.00, 0.94, 0.68, 1.01 and 0.77 points for the subsamples of wage employment, self-employment, out-of-work, home maker, students, retired and unable-to-work respectively. Results remained robust when different unemployment rate measures and different models were used.

In conclusion, local economic conditions measured by county-level unemployment rates were associated with individual seasonal flu vaccination, especially for people who were employed or living in metropolitan counties. Public health interventions may be used to improve flu vaccination during economic recessions.