Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries.
Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries.
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DOI：
10.1001/jamainternmed.2020.7484
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发表时间：
2021-03-01
影响因子：
39
通讯作者：
Skinner J
中科院分区：
文献类型：
--
作者：
Emanuel EJ;Gudbranson E;Van Parys J;Gørtz M;Helgeland J;Skinner J
生活在1%和5%最富裕县的美国白人公民的健康状况是否好于其他发达国家普通居民的健康状况？在这项关于6项健康结果的比较有效性研究中，收入最高的1%和5%县的美国白人公民的健康结果好于普通美国公民，但与其他发达国家的普通公民相比，婴儿和孕产妇死亡率、结肠癌、儿童急性淋巴细胞性白血病和急性心肌梗死的结果更差。在6个健康结果中，生活在最富有的1%和5%的县的美国白人公民的健康结果好于普通美国公民，但并不总是好于许多其他发达国家的平均居民，这表明在美国，即使每个人都达到了生活在最富有的1%和5%的县的美国白人公民的健康结果，健康指标仍将落后于许多其他国家。美国的平均健康结果不如其他发达国家的平均健康结果。然而，高收入的美国公民是否比其他发达国家的普通人拥有更好的健康状况尚不得而知。评估居住在1%和5%最富裕县的美国白人公民(以下简称特权美国白人公民)的健康状况是否好于其他发达国家普通居民的健康状况。这项比较有效性研究于2013年1月1日至2015年12月31日期间进行，确定了居住在美国收入最高的1%(n = 32)和5%(n = 157)县的美国白人公民，并测量了以下6项与医疗干预相关的健康结果：婴儿和孕产妇死亡率、结肠癌和乳腺癌、儿童急性淋巴细胞白血病和急性心肌梗死。这项研究使用了经济合作与发展组织的数据、协和-3癌症数据和医疗保险数据，将他们的结果与其他12个发达国家的所有居民进行了比较：澳大利亚、奥地利、加拿大、丹麦、芬兰、法国、德国、日本、荷兰、挪威、瑞典和瑞士。统计分析发生在2017年7月25日至2020年8月29日。婴儿死亡率；产妇死亡率；结肠癌、乳腺癌或儿童急性淋巴细胞性白血病患者的5年生存率；以及急性心肌梗死后30天的标准化病例死亡率。在收入最高的5%的县中，白人美国公民的婴儿死亡率为4.01‰，在收入最高的5%的县中，美国白人公民的产妇死亡率为10.85‰ ，均高于12个比较国家的平均死亡率。(前1%县的婴儿死亡率为3.54‰，孕产妇死亡率为10.05‰ 。)在收入最高的5%的县，美国白人结肠癌的5年生存率为67.2%(95%CI，66.7%-67.7%)，高于6个国家的平均美国公民(64.9%[95%CI，64.7%-65.1%])和普通公民，与4个国家的平均公民相当，低于2个国家的平均公民。在美国收入最高的5%的县中，美国白人女性乳腺癌的5年存活率为92.0%(95%可信区间，91.6%-92.4%)，高于所有12个比较国家。在美国收入最高的5%的县，患有急性淋巴细胞白血病的白人儿童的5年存活率为92.6%(95%可信区间，90.7%-94.2%)，超过了只有1个国家的平均存活率，与11个国家的平均存活率相当。在美国收入最高的5%的县，美国白人公民的调整后30天急性心肌梗死病死率比所有美国公民的死亡率低8%，比美国收入最高的1%县的所有美国公民的死亡率低5%；这些估计与其他高收入国家的中位数结果相似。这项研究表明，享有特权的美国白人公民在6个健康结果方面比普通美国公民有更好的健康结果，但往往比其他12个发达国家的平均健康结果更差。这些发现意味着，即使所有美国公民都享受到了与享有特权的美国白人公民一样的健康结果，美国的健康指标仍将落后于许多其他国家。这项比较有效性研究评估了生活在1%和5%最富裕县的美国白人公民的健康结果是否好于其他发达国家普通居民的健康结果。
Are the health outcomes of White US citizens living in the 1% and 5% richest counties better than the health outcomes of average residents in other developed countries? In this comparative effectiveness study of 6 health outcomes, White US citizens in the 1% and 5% highest-income counties obtained better health outcomes than average US citizens but had worse outcomes for infant and maternal mortality, colon cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction compared with average citizens of other developed countries. For 6 health outcomes, the health outcomes of White US citizens living in the 1% and 5% richest counties are better than those of average US citizens but are not consistently better than those of average residents in many other developed countries, suggesting that in the US, even if everyone achieved the health outcomes of White US citizens living in the 1% and 5% richest counties, health indicators would still lag behind those in many other countries. The average health outcomes in the US are not as good as the average health outcomes in other developed countries. However, whether high-income US citizens have better health outcomes than average individuals in other developed countries is unknown. To assess whether the health outcomes of White US citizens living in the 1% and 5% richest counties (hereafter referred to as privileged White US citizens) are better than the health outcomes of average residents in other developed countries. This comparative effectiveness study, conducted from January 1, 2013, to December 31, 2015, identified White US citizens living in the 1% (n = 32) and 5% (n = 157) highest-income counties in the US and measured the following 6 health outcomes associated with health care interventions: infant and maternal mortality, colon and breast cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction. The study used Organisation for Economic Co-operation and Development data, CONCORD-3 cancer data, and Medicare data to compare their outcomes with all residents in 12 other developed countries: Australia, Austria, Canada, Denmark, Finland, France, Germany, Japan, the Netherlands, Norway, Sweden, and Switzerland. Statistical analysis took place from July 25, 2017, to August 29, 2020. Infant mortality; maternal mortality; 5-year survival of patients with colon cancer, breast cancer, or childhood acute lymphocytic leukemia; and 30-day age-standardized case fatality after acute myocardial infarction. The infant mortality rate among White US citizens in the 5% highest-income counties was 4.01 per 1000, and the maternal mortality rate among White US citizens in the 5% highest-income counties was 10.85 per 100 000, both higher than the mean rates for any of the 12 comparison countries. (The infant mortality rate for the top 1% counties was 3.54 per 1000, and the maternal mortality rate was 10.05 per 100 000.) The 5-year survival rate for White US citizens in the 5% highest-income counties was 67.2% (95% CI, 66.7%-67.7%) for colon cancer, higher than that of average US citizens (64.9% [95% CI, 64.7%-65.1%]) and average citizens in 6 countries, comparable with that of average citizens in 4 countries, and lower than that of average citizens for 2 countries. The 5-year survival rate for breast cancer among White US women in the 5% highest-income US counties was 92.0% (95% CI, 91.6%-92.4%), higher than in all 12 comparison countries. The 5-year survival rate for White children with acute lymphocytic leukemia in the 5% highest-income US counties was 92.6% (95% CI, 90.7%-94.2%), exceeding the mean survival rate for only 1 country and comparable with the mean survival rates in 11 countries. The adjusted 30-day acute myocardial infarction case-fatality rate for White US citizens in the 5% highest-income US counties was 8% below the rate for all US citizens and was 5% below the rate for all US citizens in the 1% highest-income US counties; these estimates were similar to the median outcome of other high-income countries. This study suggests that privileged White US citizens have better health outcomes than average US citizens for 6 health outcomes but often fare worse than the mean measure of health outcomes of 12 other developed countries. These findings imply that even if all US citizens experienced the same health outcomes enjoyed by privileged White US citizens, US health indicators would still lag behind those in many other countries. This comparative effectiveness study assesses whether the health outcomes of White US citizens living in the 1% and 5% richest counties are better than the health outcomes of average residents in other developed countries.
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DOI：
10.1001/jama.2016.4226
发表时间：
2016-04-26
期刊：
JAMA
影响因子：
--
作者：
Chetty R;Stepner M;Abraham S;Lin S;Scuderi B;Turner N;Bergeron A;Cutler D
通讯作者：
Cutler D
影响因子：
15.8
作者：
Murray CJ;Kulkarni SC;Michaud C;Tomijima N;Bulzacchelli MT;Iandiorio TJ;Ezzati M
通讯作者：
Ezzati M
影响因子：
5.3
作者：
Chen, Alice;Oster, Emily;Williams, Heidi
通讯作者：
Williams, Heidi
影响因子：
120.7
作者：
Moses, Hamilton, III;Matheson, David H. M.;Yoshimura, Satoshi
通讯作者：
Yoshimura, Satoshi
影响因子：
9.7
作者：
Dickman, Samuel L.;Woolhandler, Steffie;Himmelstein, David U.
通讯作者：
Himmelstein, David U.