What Changes In Survival Rates Tell Us About US Health Care

[Slartibartfast]

ABSTRACT Many advocates of US health reform point to the nation’s
relatively low life-expectancy rankings as evidence that the health care
system is performing poorly. Others say that poor US health outcomes are
largely due not to health care but to high rates of smoking, obesity,
traffic fatalities, and homicides. We used cross-national data on the
fifteen-year survival of men and women over three decades to examine
the validity of these arguments. We found that the risk profiles of
Americans generally improved relative to those for citizens of many other
nations, but Americans’ relative fifteen-year survival has nevertheless
been declining. For example, by 2005, fifteen-year survival rates for fortyfive-
year-old US white women were lower than in twelve comparison
countries with populations of at least seven million and per capita gross
domestic product (GDP) of at least 60 percent of US per capita GDP in
1975. The findings undercut critics who might argue that the US health
care system is not in need of major changes.

This study, even accounting for differences in healthy culture has found worse outcomes for US citizens in regards to health care.

 

[MKULTRABOY]

link? ? ? ?/???//

 

[Slartibartfast]

Doh!

http://content.healthaffairs.org/cgi/reprint/hlthaff.2010.0073v1.pdf

 

[phattonez]

Maybe I'm missing something, but how does this survival rate avoid the claims of obesity, traffic fatalities, etc.? I don't see how those things were controlled in this study.

 

[Slartibartfast]

Maybe I'm missing something, but how does this survival rate avoid the claims of obesity, traffic fatalities, etc.? I don't see how those things were controlled in this study.

The study uses coding to weed out accidents and obesity is specifically addressed on page 6.

For obesity to explain the decline in US life
expectancy or the increase in health spending
relative to the twelve comparison countries,
Americans would have to be becoming obese
at a faster rate than people in the comparison
nations over time. Exhibit 3 shows that the
United States has generally had a slower rate
of growth in the percentage of obese men and
women over this period

In fact, the share of all deaths in the age groups
under study attributable to homicides and traffic
accidents has been relatively low and quite stable
over time. These causes of death are therefore
unlikely to account for the deteriorating survival
probabilities of Americans (Exhibit 4).

 

[phattonez]

Wait a second, doesn't this study which follows people over time involve telling the people being studied that they are being studied?

 

[Slartibartfast]

Wait a second, doesn't this study which follows people over time involve telling the people being studied that they are being studied?

They used datasets from other studies to arrive to their conclusions, according to the summary I posted in the OP.

 

[phattonez]

Well here's a list of their own self-admitted problems.

Second, we did not use comparative data on
specific causes of death.

...

Finally, we examined only relative changes in
smoking and obesity over time.

The second one is more interesting, as physical activity, stress, drinking habits, drug usage, hours of sleep, etc. all of significant effects on overall health level. Diet is a big one I see that was not controlled.

 

[Slartibartfast]

Well here's a list of their own self-admitted problems.



The second one is more interesting, as physical activity, stress, drinking habits, drug usage, hours of sleep, etc. all of significant effects on overall health level. Diet is a big one I see that was not controlled.

They did account for behavioral risk factors, which is a category that you have a concern about. However, there is no evidence that these other risk factors have much of an impact. Especially considering the overwhelming data of all other countries :shrug:

However, the first concern is a limitation on the available data. However, general causes of death appear to be accounted for.

 

[phattonez]

They did account for behavioral risk factors, which is a category that you have a concern about.

However, the first concern is a limitation on the available data. However, general causes of death appear to be accounted for.

From what I saw the only behaviors that they controlled for were smoking and obesity. Did I miss a mention of these other factors?

 

[Slartibartfast]

From what I saw the only behaviors that they controlled for were smoking and obesity. Did I miss a mention of these other factors?

Limitations Our study used longitudinal data,
which helped eliminate idiosyncratic findings
and allowed us to observe the temporal relationship
between changes in behavioral risk factors,
costs, and life expectancy. In addition, we focused
on survival for people ages forty-five and
sixty-five, which improved the comparability of
the data across countries.

 

[phattonez]

Longitudnal data is just studying people over a long period of time. If they're not looking at the amount of physical activity, then it's not controlled. Over time the European may have more physical activity than the American. Longitudnal studies don't deal with this problem unless it is controlled.

 

[Slartibartfast]

Thinking about it, if other factors like sleep habits, diet, etc are what is holding us back from what our spending on health should be doing for us in terms of our life expectancy (assuming our pre healthcare bill system is at least as good per $ spent as a less market based one is), than we must have the absolute worst habits in the world. I don't think that conclusion holds up to what I have observed though..

 

[phattonez]

Thinking about it, if other factors like sleep habits, diet, etc are what is holding us back from what our spending on health should be doing for us in terms of our life expectancy (assuming our pre healthcare bill system is at least as good per $ spent as a less market based one is), than we must have the absolute worst habits in the world. I don't think that conclusion holds up to what I have observed though..

Obesity, sedentary lifestyle, rich foods, stress, these are all hugely important factors in chronic illness.

 

[Slartibartfast]

Longitudnal data is just studying people over a long period of time. If they're not looking at the amount of physical activity, then it's not controlled. Over time the European may have more physical activity than the American. Longitudnal studies don't deal with this problem unless it is controlled.

Again, behavioral factors were accounted for, see my quoted text.

 

[Slartibartfast]

Obesity, sedentary lifestyle, rich foods, stress, these are all hugely important factors in chronic illness.

I agree, but is there evidence that Americans have significantly more of this than other cultures?

Also, again I quoted the portion of the study that deals with this.

 

[phattonez]

I agree, but is there evidence that Americans have significantly more of this than other cultures?

Also, again I quoted the portion of the study that deals with this.

You only quoted about longitudnal data. That tries to minimize the effects of short-term problems like stress from a divorce, stress from job loss, etc. It takes care of those things, but unless the other factors I mentioned are specifically controlled then they could skew the data.

 

[phattonez]

I agree, but is there evidence that Americans have significantly more of this than other cultures?

Also, again I quoted the portion of the study that deals with this.

BBC NEWS | Health | Obesity: in statistics

Drug Use by Country [PIC]

Hard to find data on activity levels and stress levels though.

 

[Slartibartfast]

BBC NEWS | Health | Obesity: in statistics

Drug Use by Country [PIC]

Hard to find data on activity levels and stress levels though.

So, in other words, you think we live such a significantly worse lifestyle that it is the main reason why our health care appears ineffective?

 

[phattonez]

So, in other words, you think we live such a significantly worse lifestyle that it is the main reason why our health care appears ineffective?

Absolutely. When you think of what is most important in health care, it's not healthcare, it's lifestyle (since the diseases that are the main killers in industrialized nations develop chronically instead of acutely).

* Heart disease: 616,067
* Cancer: 562,875
* Stroke (cerebrovascular diseases): 135,952
* Chronic lower respiratory diseases: 127,924
* Accidents (unintentional injuries): 123,706
* Alzheimer's disease: 74,632
* Diabetes: 71,382
* Influenza and Pneumonia: 52,717
* Nephritis, nephrotic syndrome, and nephrosis: 46,448
* Septicemia: 34,828

The diseases that I bolded are among the top killers and can largely be avoided with lifestyle changes. Yes, lifestyle is the main reason why our healthcare appears ineffective. Our healthcare system could be better, but I think more of a market system instead of UHC would be the best option, though that is a subject for another thread.

In case you're wondering, these diseases that develop chronically make up about 70% of the deaths among top killers.