Association of armed conflict and global measles cases: A structural equation modeling analysis of 193 countries from 2000 to 2023

by Tyler Y. Headley, Yesim Tozan Background Global armed conflict and population displacement are increasing, yet their association with population health remains poorly understood.

We developed and tested four theoretical models linking armed conflict, population displacement, and socioeconomic development to measles burden across 193 countries from 2000 to 2023. Methods and findings We analyzed longitudinal country-level data comprising 4,632 country-year observations, combining fixed-effects panel regression and structural equation modeling (SEM).

Observed variables included battle-related deaths (BRDs) and forcibly displaced population sizes, while socioeconomic development was modeled as a latent variable incorporating gross domestic product (GDP) per capita, life expectancy, and mean years of schooling. Outcomes were total measles cases and incidence per million population.

All four constructed models demonstrated excellent fit (Comparative Fit Index [CFI] 0.991–0.996; Tucker–Lewis Index [TLI] 0.976–0.989; Root Mean Square Error of Approximation [RMSEA] 0.046–0.062).