Left behind: widening disparities for males and females in US county life expectancy, 1985–2010
Tóm tắt
The United States spends more than any other country on health care. The poor relative performance of the US compared to other high-income countries has attracted attention and raised questions about the performance of the US health system. An important dimension to poor national performance is the large disparities in life expectancy.
We applied a mixed effects Poisson statistical model and Gaussian Process Regression to estimate age-specific mortality rates for US counties from 1985 to 2010. We generated uncertainty distributions for life expectancy at each age using standard simulation methods.
Female life expectancy in the United States increased from 78.0 years in 1985 to 80.9 years in 2010, while male life expectancy increased from 71.0 years in 1985 to 76.3 years in 2010. The gap between female and male life expectancy in the United States was 7.0 years in 1985, narrowing to 4.6 years in 2010. For males at the county level, the highest life expectancy steadily increased from 75.5 in 1985 to 81.7 in 2010, while the lowest life expectancy remained under 65. For females at the county level, the highest life expectancy increased from 81.1 to 85.0, and the lowest life expectancy remained around 73. For male life expectancy at the county level, there have been three phases in the evolution of inequality: a period of rising inequality from 1985 to 1993, a period of stable inequality from 1993 to 2002, and rising inequality from 2002 to 2010. For females, in contrast, inequality has steadily increased during the 25-year period. Compared to only 154 counties where male life expectancy remained stagnant or declined, 1,405 out of 3,143 counties (45%) have seen no significant change or a significant decline in female life expectancy from 1985 to 2010. In all time periods, the lowest county-level life expectancies are seen in the South, the Mississippi basin, West Virginia, Kentucky, and selected counties with large Native American populations.
The reduction in the number of counties where female life expectancy at birth is declining in the most recent period is welcome news. However, the widening disparities between counties and the slow rate of increase compared to other countries should be viewed as a call for action. An increased focus on factors affecting health outcomes, morbidity, and mortality such as socioeconomic factors, difficulty of access to and poor quality of health care, and behavioral, environmental, and metabolic risk factors is urgently required.
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Tài liệu tham khảo
Wang H, Dwyer-Lindgren L, Lofgren KT, Rajaratnam JK, Marcus JR, Levin-Rector A, Levitz CE, Lopez AD, Murray CJ: Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012, 380: 2071-2094. 10.1016/S0140-6736(12)61719-X.
Dougherty DCP: The “3t’s” road map to transform us health care: the “how” of High-quality care. JAMA. 2008, 299: 2319-2321. 10.1001/jama.299.19.2319.
Emanuel EJFV: The perfect storm of overutilization. JAMA. 2008, 299: 2789-2791. 10.1001/jama.299.23.2789.
Peterson CL, Rachel B: US Health Care Spending: Comparison with Other OECD Countries. 2007, Washington, DC: Congressional Research Service Federal Publications
Fuchs VR: How and why US health care differs from that in other OECD countries. Jama J Am Med Assoc. 2013, 309: 33-34. 10.1001/jama.2012.125458.
U.S. Health in International Perspective: Shorter Lives, Poorer Health. Edited by: Woolf SH, Aron L. 2013, Washington, DC: The National Academies Press
Ho JY: Mortality Under Age 50 accounts for Much of the fact That US life expectancy lags That of other High-income countries. Health Aff (Millwood). 2013, 32: 459-467. 10.1377/hlthaff.2012.0574.
Ezzati M, Friedman AB, Kulkarni SC, Murray CJL: The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United states. Plos Med. 2008, 5: e66-10.1371/journal.pmed.0050066.
Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, Iandiorio TJ, Ezzati M: Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United states. Plos Med. 2006, 3: e260-10.1371/journal.pmed.0030260.
Cullen MR, Cummins C, Fuchs VR: Geographic and racial variation in premature mortality in the U.S.: analyzing the disparities. Plos One. 2012, 7: e32930-10.1371/journal.pone.0032930.
Kulkarni SC, Levin-Rector A, Ezzati M, Murray CJ: Falling behind: life expectancy in US counties from 2000 to 2007 in an international context. Popul Heal Metrics. 2011, 9: 16-10.1186/1478-7954-9-16.
Koh HK, Graham G, Glied SA: Reducing racial and ethnic disparities: the action plan from the department of health and human services. Heal Aff Proj Hope. 2011, 30: 1822-1829. 10.1377/hlthaff.2011.0673.
Miech R, Pampel FC, Jinyoung K, Rogers RG: The enduring association between education and mortality: the role of widening and narrowing disparities. Am Sociol Rev. 78: 913-934.
Keppel KG, Pearcy JN, Wagener DK: Trends in racial and ethnic-specific rates for the health status indicators: United States, 1990–98. Heal People 2000 Stat Notes Natl Cent Heal Stat. 2002, 1-16.
Asada Y: Assessment of the health of Americans: the average health-related quality of life and its inequality across individuals and groups. Popul Heal Metrics. 2005, 3: 7-10.1186/1478-7954-3-7.
Kindig DA, Cheng ER: Even as mortality fell in most US counties, female mortality nonetheless rose in 42.8 Percent of counties from 1992 to 2006. Health Aff (Millwood). 2013, 32: 451-458. 10.1377/hlthaff.2011.0892.
Srebotnjak T, Mokdad AH, Murray CJ: A novel framework for validating and applying standardized small area measurement strategies. Popul Heal Metrics. 2010, 8: 26-10.1186/1478-7954-8-26.
Cancer Facts and Figures: Cancer Facts and Figures, 2010. 2010, Atlanta, GA: American Cancer Society
Preston SH, Wang H: Sex mortality differences in the United states: the role of cohort smoking patterns. Demography. 2006, 43: 631-646. 10.1353/dem.2006.0037.
Pampel FC: Declining sex differences in mortality from lung cancer in high-income nations. Demography. 2003, 40: 45-65. 10.1353/dem.2003.0007.
Dwyer-Lindgren L, Freedman G, Engell R, Fleming T, Lim SS, Mokdad AH, Christopher MJL: Prevalence of physical activity in US counties 2001–2011: a road Map for action. Population Health Metrics. 11: 7-
Flegal KMCM: Prevalence and trends in obesity among us adults, 1999–2000. JAMA. 2002, 288: 1723-1727. 10.1001/jama.288.14.1723.
Signs, Vital: “State-specific Obesity Prevalence Among Adults - United States, 2009.” Morbidity and Mortality Weekly Report. 2010, 951-955.
Winkleby MA, Jatulis DE, Frank E, Fortmann SP: Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992, 82: 816-820. 10.2105/AJPH.82.6.816.
Sudano JJ, Baker DW: Explaining US racial/ethnic disparities in health declines and mortality in late middle age: the roles of socioeconomic status, health behaviors, and health insurance. Soc Sci Med. 2006, 62: 909-922. 10.1016/j.socscimed.2005.06.041.
Caldwell JC: Education as a factor in mortality decline an examination of nigerian data. Popul Stud. 1979, 33: 395-413. 10.2307/2173888.
Gakidou E, Cowling K, Lozano R, Murray CJ: Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet. 2010, 376: 959-974. 10.1016/S0140-6736(10)61257-3.
Cutler DM, Lleras-Muney A: Education and Health: Evaluating Theories and Evidence. Working Paper. 2006, Cambridge, MA: National Bureau of Economic Research
Lynch SM: Cohort and life-course patterns in the relationship between education and health: A hierarchical approach. Demography. 2003, 40: 309-331. 10.1353/dem.2003.0016.
Hobcraft J: Women’s education, child welfare and child survival: a review of the evidence. Health Transit Rev. 1993, 3: 159-175.
Panel on Understanding Cross-National Health Differences Among High-Income Countries; Committee on Population; Division of Behavioral and Social Sciences and Education; National Research Council; Board on Population Health and Public Health Practice; Institute of Medicine: U.S. Health in International Perspective: Shorter Lives, Poorer Health. Edited by: Woolf SH, Laudan A. 2013, Washington, D.C: The National Academies Press
Ayanian JZ, Kohler BA, Abe T, Epstein AM: The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993, 329: 326-331. 10.1056/NEJM199307293290507.
Brook RH, Ware JE, Rogers WH, Keeler EB, Davies AR, Donald CA, Goldberg GA, Lohr KN, Masthay PC, Newhouse JP: Does free care improve Adults’ health?. N Engl J Med. 1983, 309: 1426-1434. 10.1056/NEJM198312083092305.
Young PL, Leigh Anne O, Michael McGinnis J: Roundtable on Evidence-Based Medicine; Institute of Medicine: Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. 2010, Washington, D.C: The National Academies Press
Olives C, Myerson R, Mokdad AH, Murray CJL, Lim SS: Prevalence, awareness, treatment, and control of hypertension in United states counties, 2001–2009. Plos One. 2013, 8: e60308-10.1371/journal.pone.0060308.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, AlMazroa MA, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, et al: A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012, 380: 2224-2260. 10.1016/S0140-6736(12)61766-8.
Danaei G, Rimm EB, Oza S, Kulkarni SC, Murray CJL, Ezzati M: The promise of prevention: the effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United states. Plos Med. 2010, 7: e1000248-10.1371/journal.pmed.1000248.
Galuska DA, Will JC, Serdula MK, Ford ES: Are health care professionals advising obese patients to lose weight?. Jama J Am Med Assoc. 1999, 282: 1576-1578. 10.1001/jama.282.16.1576.
Denny CH, Serdula MK, Holtzman D, Nelson DE: Physician advice about smoking and drinking: are U.S. adults being informed?. Am J Prev Med. 2003, 24: 71-74. 10.1016/S0749-3797(02)00568-8.
Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N: Toward higher-performance health systems: adults’ health care experiences in seven countries, 2007. Health Aff (Millwood). 2007, 26: w717-w734. 10.1377/hlthaff.26.6.w717.
Prevention Agenda: Toward the Healthiest State. http://www.health.ny.gov/prevention/prevention_agenda/physical_activity_and_nutrition/,
Lewin S, Dick J, Pond P, Zwarenstein M, Aja GN, van Wyk BE, Bosch-Capblanch X, Patrick M: Lay health workers in primary and community health care. Cochrane Database Syst Rev. Edited by: The Cochrane Collaboration, Lewin S. 2005, Chichester, UK: John Wiley & Sons, Ltd
Jacobson Vann JC, Szilagyi P: Patient reminder and recall systems to improve immunization rates. Cochrane Database Syst Rev. Edited by: The Cochrane Collaboration, Jacobson Vann JC. 2005, Chichester, UK: John Wiley & Sons, Ltd
Jaén CR, McIlvain H, Pol L, Phillips RL, Flocke S, Crabtree BF: Tailoring tobacco counseling to the competing demands in the clinical encounter. J Fam Pract. 2001, 50: 859-863.
Crabtree BF, Miller WL, Tallia AF, Cohen DJ, DiCicco-Bloom B, McIlvain HE, Aita VA, Scott JG, Gregory PB, Stange KC, McDaniel RR: Delivery of clinical preventive services in family medicine offices. Ann Fam Med. 2005, 3: 430-435. 10.1370/afm.345.
Goldstein MG, Whitlock EP, DePue J: Multiple behavioral risk factor interventions in primary care: Summary of research evidence. Am J Prev Med. 2004, 27 (2, Supplement): 61-79. 10.1016/j.amepre.2004.04.023.
Congdon P: Estimating life expectancies for US small areas: a regression framework. J Geogr Syst. 1-18.