US Mortality in an International Context: Age Variations
US Mortality in an International Context: Age Variations
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DOI：
10.1111/j.1728-4457.2010.00356.x
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发表时间：
2010-12-01
影响因子：
2.5
通讯作者：
Preston, Samuel H.
中科院分区：
文献类型：
--
作者：
Ho, Jessica Y.;Preston, Samuel H.
与其他发达国家相比，美国在50岁时的预期寿命排名较低。我们试图通过比较18个发达国家的老年死亡率来揭示美国的低预期寿命排名。出现了一个惊人的模式：在40岁到75岁之间，美国的全因死亡率在比较的国家中是最贫穷的。美国男性和女性的地位在75岁以后都有了显著的改善。我们考虑了这一分析揭示的年龄模式的四种可能的解释：(1)获得医疗保险的机会；(2)吸烟模式的国际差异；(3)医疗保健系统绩效的年龄模式；以及(4)选择过程。我们发现，健康保险和吸烟并不是这种年龄模式的可信来源。虽然我们不能排除选择的可能性，但我们提出了一些提示性证据，表明美国医疗体系在高龄时异常积极地部署救生技术，正在推动美国死亡率排名的年龄模式。肥胖分布的差异可能会对这一模式做出适度的贡献，但与肥胖相关的风险的不确定性阻碍了准确的评估。
Compared to other developed countries, the United States ranks poorly in terms of life expectancy at age 50. We seek to shed light on the US's low life expectancy ranking by comparing the age-specific death rates of 18 developed countries at older ages. A striking pattern emerges: between ages 40 and 75, US all-cause mortality rates are among the poorest in the set of comparison countries. The US position improves dramatically after age 75 for both males and females. We consider four possible explanations of the age patterns revealed by this analysis: (1) access to health insurance; (2) international differences in patterns of smoking; (3) age patterns of health care system performance; and (4) selection processes. We find that health insurance and smoking are not plausible sources of this age pattern. While we cannot rule out selection, we present suggestive evidence that an unusually vigorous deployment of life-saving technologies by the US health care system at very old ages is contributing to the age-pattern of US mortality rankings. Differences in obesity distributions are likely to be making a moderate contribution to the pattern but uncertainty about the risks associated with obesity prevents a precise assessment.