By David Pittman, Washington Correspondent, MedPage Today
Published: January 10, 2013
WASHINGTON -- Despite spending more on healthcare, Americans die sooner and experience more illness than people in other high-income countries, a study released Wednesday found.
For example, lung disease was more prevalent and associated with higher mortality in the U.S. compared with other countries, and American children were less likely to live to age 5, according to the report Shorter Lives, Poorer Health, issued by the National Research Council and the Institute of Medicine.
Researchers were surprised by the gravity and pervasiveness of the disparities and couldn't pinpoint a cause to a specific disease, said study chair Steven Woolf, MD, professor of family medicine at the Virginia Commonwealth University in Richmond, Va. Poor health results also can't be blamed on a single racial, ethnic, or socioeconomic group, he added.
The disparity found between the U.S. and 16 comparable countries showed itself in all ages, from birth to 75. And while the U.S.'s mortality rate has been lagging for some time, the report found poor comparable health status cuts across income, education levels, and health insurance status.
"No single factor, but a combination is likely to explain the U.S. health disadvantage," Woolf said in a call with reporters Wednesday.
For the report, the blue-ribbon panel compared health outcomes in the U.S. to 16 comparable high-income or peer countries. It found a consistent pattern of higher mortality and poorer health in the U.S. for every 5-year age group starting from birth.
Specifically, the panel found:
- Since the 1990s, U.S. adolescents have had the highest rate of pregnancies and have been more likely to acquire sexually transmitted infections
- The U.S. has the highest prevalence of HIV infection for ages 15-49
- Americans have lost more years of life to alcohol and other drugs than people in peer countries
- For decades, the U.S. has had the highest obesity rate among high-income countries
- From age 20 onward, U.S. adults have among the highest prevalence of diabetes among peer countries
- Americans reached age 50 with a less favorable cardiovascular risk profile than their peers in Europe
"Americans who do reach age 50 generally arrive at this age in poorer health than their counterparts in other high-income countries, and as older adults they face greater morbidity and mortality from chronic diseases that arise from risk factors that are often established earlier in life," the report stated.
While there are many possible causes, one leading factor is American culture, which tends to cherish personal autonomy and less government intrusion -- attitudes that produce more unsafe and unhealthy behaviors, Woolf said.
Americans also rely on cars for transportation more and eat food generally prepared in a less healthy way. And the U.S. has a smaller number of primary care providers than its peer countries and greater problems coordinating care, the study found.
Despite America's severe disadvantage in health outcomes, the research found hospital mortality rates are comparable to other countries. "It's when people leave the hospital and go out into the community that quality of life drops off," Woolf said.
Americans need to distinguish between the country's healthcare system -- for which people already spend far more per capita than their peers -- and their personal health. "This study would suggest we need to think about the way we spend our money," Woolf said.
In contrast to all other age groups, Americans age 75 and older fare better than their counterparts in peer countries, the study found.
The U.S. also has better cancer screening and survival rates, better control of blood pressure and cholesterol levels, and lower smoking rates. Its suicide rates don't exceed the international average.
Also, the nation's recent immigrants are generally in better health than native-born Americans, the study found.
Panelists offered a number of policy and research suggestions to move forward.
The country should ramp up efforts to curb disadvantages, they suggested, while philanthropy and advocacy groups organize media and outreach campaigns to inform the general public about its findings to encourage national debate.
New research is needed to uncover the best ways of improving health in the future, the report suggested. The country should work with international partners to harmonize indicators and data collection, and the National Institutes of Health and other research agencies should commit to understanding the factors behind the U.S.'s health disadvantage and lessons learned from other countries.