Why we die young compared to other high-income countries--homicide, car accidents, drug overdoses, mental health...
According to a recent study by Ho published in Health Affairs this month, a significant gap (2/3 of the difference for males and 2/5 for females) between the US and the mean of the comparison countries in life expectancy at birth is explained by mortality differences below age 50. The major drivers of differences in life expectancy at birth for males in 2007 were homicide, unintentional injuries, perinatal conditions and NCDs; for females, unintentional injuries, NCDs and perinatal conditions are the main contributors to excess mortality under 50. The author (and my own bias included) alluded to policy implications focusing on younger ages such as: income inequality, urban poverty, residential segregation, gun ownership and availability, public transportation, traffic safety (annual number of km driven in the US exceeds that in the comparison countries), prescription drug monitoring programs (Americans consume more prescription medications than any other populations as well). Along the same theme...
In the Global Burden of Disease 2010 Study, violence as a cause of YLLs (years of life lost due to premature mortality) is 7 per 100,000 in the US (seven times higher than high-income Asia-Pacific, western Europe or Australasia); but in tropical and central Latin America, the rates are substantially higher 30+/100,000. The huge variation in violence mortality reflects (again) socioeconomic inequalities, political contexts and public health strategies. There are lessons, policy implications for governments, leaders if they care about these outcomes.
A study by Kindig and Cheng in the same issue in Health Affairs added to the body of literature on the regional variation in health outcomes in the US. The authors examined trends in male and female mortality rates from 1992-96 to 2002-06 using county-level data from the County Health Rankings, BRFSS, CDC database and US census with a number of covariates including geographic regions, household income, educational levels, single-parent households, children below federal poverty level, smoking, obesity, PCPs, insurance coverage, preventable hospitalizations, etc.
Sure mortality rates are falling in most US counties but a large number of counties (43%) had no reduction in female mortality rates during the study period. The authors identified a number of factors most strongly asociated with mortality change including education levels, the region the county was located in (south vs. northeast), and smoking rates. Higher proportions of Hispanics and adults with a college degree (see my previously blog and our journal club) were associated with reductions in mortality rates. And remember mortality rates (male or female) were NOT predicted by any of the medical care factors such as rates of primary care providers, preventable hospitalizations or precentage of uninsured.
So where should we put most of our money and resources--education, housing, neighborhoods.
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"