Impact of State Public Health Spending on Disease Incidence in the United States from 1980 to 2009

Reetu Verma, Samantha Clark, Jonathon Leider, David Bishai

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: To understand the relationship between state-level spending by public health departments and the incidence of three vaccine preventable diseases (VPDs): mumps, pertussis, and rubella in the United States from 1980 to 2009. Data Sources: This study uses state-level public health spending data from The Census Bureau and annual mumps, pertussis, and rubella incidence counts from the University of Pittsburgh's project Tycho. Study Design: Ordinary least squares (OLS), fixed effects, and random effects regression models were tested, with results indicating that a fixed effects model would be most appropriate model for this analysis. Principal Findings: Model output suggests a statistically significant, negative relationship between public health spending and mumps and rubella incidence. Lagging outcome variables indicate that public health spending actually has the greatest impact on VPD incidence in subsequent years, rather than the year in which the spending occurred. Results were robust to models with lagged spending variables, national time trends, and state time trends, as well as models with and without Medicaid and hospital spending. Conclusion: Our analysis indicates that there is evidence of a significant, negative relationship between a state's public health spending and the incidence of two VPDs, mumps and rubella, in the United States.

Original languageEnglish (US)
Pages (from-to)176-190
Number of pages15
JournalHealth services research
Issue number1
StatePublished - Feb 1 2017
Externally publishedYes

Bibliographical note

Funding Information:
Joint Acknowledgment/Disclosure Statement: David Bishai received research support from the deBeaumont Foundation. Reetu Verma received research guidance and support from Dr. David Bishai and Johns Hopkins Bloomberg School of Public Health. Disclosures: None. Disclaimers: None.

Publisher Copyright:
© Health Research and Educational Trust


  • CHIP
  • Tycho
  • vaccination
  • vaccine preventable diseases
  • VFC


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