U.S. Life Expectancy
Falls Behind Major Countries, Despite Highest Health Spending
Obesity, smoking, traffic fatalities and homicide
ruled out as causes of failure of US to keep up with gains in life
expectancy in other countries
October 7,
2010—America continues to lag behind other nations when it comes to
gains in life expectancy, and commonly cited causes for our poor
performance—obesity, smoking, traffic fatalities and homicide—are not to
blame, according to a study by researchers at Columbia University's
Mailman School of Public Health.
While the U.S.
has achieved gains in 15-year survival rates decade by decade between
1975 and 2005, the researchers discovered that other countries have
experienced even greater gains, leading the U.S. to slip in country
ranking, even as per capita health care spending in the U.S. increased
at more than twice the rate of the comparison countries.
Fifteen-year
survival rates for men and women ages 45 and 65 in the U.S. have fallen
relative to the other 12 countries over the past 30 years. Forty-five
year old U.S. white women fared the worst - by 2005 their 15-year
survival rates were lower than that of all the other countries.
Moreover, the
survival rates of this group in 2005 had not even surpassed the 1975
15-year survival rates for Swiss, Swedish, Dutch or Japanese women. The
U.S. ranking for 15-year life expectancy for 45-year-old men also
declined, falling from 3rd in 1975 to 12th in 2005.
The study looked
at health spending; behavioral risk factors like obesity and smoking;
and 15-year survival rates for men and women ages 45 and 65 in the U.S.
and 12 other nations -- Australia, Austria, Belgium, Canada, France,
Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, and the
United Kingdom.
When the
researchers compared risk factors among the 13 countries, they found
very little difference in smoking habits between the U.S. and the
comparison countries—in fact, the U.S. had faster declines in smoking
between 1975 and 2005 than almost all of the other countries.
In terms of
obesity, researchers found that, while people in the U.S. are more
likely to be obese, this was also the case in 1975, when the U.S. was
not so far behind in life expectancy. In fact, even as the comparison
countries pulled ahead of the U.S. in terms of survival, the percentage
of obese men and women actually grew faster in most of those countries
between 1975 and 2005.
Finally,
examining homicide and traffic fatalities, the researchers found that
they have accounted for a stable share of U.S. deaths over time, and
would not account for the significant change in 15-year life expectancy
the study identified.
The researchers
say that the failure of the U.S. to make greater gains in survival rates
with its greater spending on health care may be attributable to flaws in
the overall health care system. Specifically, they point to the role of
unregulated fee-for-service payments and our reliance on specialty care
as possible drivers of high spending without commensurate gains in life
expectancy.
"It was shocking
to see the U.S. falling behind other countries even as costs soared
ahead of them," said lead author Peter Muennig, MD, MPH, assistant
professor of Health Policy and Management at the Mailman School of
Public Health.
"But what really
surprised us was that all of the usual suspects—smoking, obesity,
traffic accidents, homicides, and racial and ethnic diversity are not
the culprits. The U.S. doesn't stand out as doing any worse in these
areas than any of the other countries we studied, leading us to believe
that failings in the U.S. health care system, such as costly specialized
and fragmented care, are likely playing a large role in this relatively
poor performance on improvements in life expectancy."
"This study
provides stark evidence that the U.S. health care system has been
failing Americans for years," said Commonwealth Fund President Karen
Davis.
"It is
unacceptable that the U.S. obtains so much less than should be expected
from its unusually high spending on health care relative to other
countries."
The good news is
that the Affordable Care Act will take significant steps to improve our
health care system and the health of Americans by expanding health
insurance, improving primary care, and holding health care organizations
accountable for their patients' overall health and ensuring the
coordination of primary care and specialty care to eliminate errors,
waste of patients' time, and wasteful duplication of tests and
services."
The Commonwealth
Fund-supported study, "What Changes in Survival Rates Tell Us About U.S.
Health Care, is published as a Health Affairs Web Exclusive.
Keep up with the latest news for senior citizens, baby
boomers
October 7,
2010—America continues to lag behind other nations when it comes to
gains in life expectancy, and commonly cited causes for our poor
performance—obesity, smoking, traffic fatalities and homicide—are not to
blame, according to a study by researchers at Columbia University's
Mailman School of Public Health. 
