Previously submitted to: JMIR Formative Research (no longer under consideration since Apr 29, 2026)
Date Submitted: Feb 19, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Cybersecurity Resilience in National Digital Health Infrastructure and Its Longitudinal Association With Mortality and Life Expectancy: A Multivariate Time-Series Analysis
ABSTRACT
Background:
National health systems are increasingly dependent on digital infrastructures to deliver essential services, manage population health data, and support evidence-based decision making. While cybersecurity resilience is widely recognized as a technical requirement for digital health systems, its long-term association with population-level health outcomes remains empirically underexplored.
Objective:
This study examines the longitudinal relationship between cybersecurity resilience in national digital health infrastructure and key population health outcomes, specifically mortality rates and life expectancy, using a multivariate time-series modeling approach
Methods:
Annual national-level data spanning the period 2010–2025 were analyzed to capture the accelerated phase of digital health transformation and formalization of cybersecurity governance frameworks. A composite Cybersecurity Maturity Index was constructed to reflect national-level digital health security readiness. Health outcomes included overall mortality, cause-specific mortality indicators, and life expectancy at birth. Multivariate time-series techniques were applied to assess dynamic associations, temporal dependencies, and directional relationships between cybersecurity resilience and health outcomes.
Results:
The findings indicate a stable long-run association between improvements in cybersecurity resilience and favorable population health outcomes. Higher levels of digital health cybersecurity maturity were associated with reductions in mortality indicators and gradual improvements in life expectancy over time. Temporal analyses suggest that changes in cybersecurity resilience precede improvements in selected health outcomes, highlighting the systemic role of secure digital infrastructure in supporting health system stability.
Conclusions:
Cybersecurity resilience should be conceptualized as a foundational component of national digital health systems rather than a purely technical concern. Strengthening cybersecurity governance and infrastructure may contribute indirectly to improved population health outcomes by enhancing the reliability, continuity, and trustworthiness of digital health services. These findings provide policy-relevant evidence for integrating cybersecurity strategies into national digital health and health system resilience frameworks
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.