Impact of State Public Health Spending on Disease Incidence in the United States from 1980 to 2009
研究了1980-2009年美国各州公共卫生支出与三种疫苗可预防疾病（腮腺炎、百日咳、风疹）发病率的关系，发现支出增加显著降低了腮腺炎和风疹的发病率，且效果在后续年份更明显。
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.