A new paper on life expectancy

by on August 10, 2009 at 2:28 pm in Medicine | Permalink

This isn't quite news, but here's the latest word, from Samuel Preston and Jessica Ho:

Life expectancy in the United States fares poorly in international
comparisons, primarily because of high mortality rates above age 50.
Its low ranking is often blamed on a poor performance by the health
care system rather than on behavioral or social factors. This paper
presents evidence on the relative performance of the US health care
system using death avoidance as the sole criterion. We find that, by
standards of OECD countries, the US does well in terms of screening for
cancer, survival rates from cancer, survival rates after heart attacks
and strokes, and medication of individuals with high levels of blood
pressure or cholesterol. We consider in greater depth mortality from
prostate cancer and breast cancer, diseases for which effective methods
of identification and treatment have been developed and where
behavioral factors do not play a dominant role. We show that the US has
had significantly faster declines in mortality from these two diseases
than comparison countries. We conclude that the low longevity ranking
of the United States is not likely to be a result of a poorly
functioning health care system.

A non-gated version is here.

fusion August 10, 2009 at 2:47 pm

The paper lists some diseases, shows rapid improvement of US outcomes for those diseases and concludes that low longevity ranking is not the result of the US healthcare system. This argument fails basic logic. That we’ve improved in some diseases shows nothing about the healthcare system in general.

They then try to blame US longevity on obesity and smoking. In one sentence they say the US is more obese than the rest of the world. On smoking, the best they can do is suggest smoking issues are to blame for a few positions in longevity rankings. If such factors are a significant part of their argument, they should spend some more time developing the argument.

Perhaps interestingly, they include data on breast cancer. Their charts show that the US has improved greatly, to the point that we now match the rest of the world.

John Dewey August 10, 2009 at 3:08 pm

fusion: “I’d add that the summary at the end of the paper is much more hedged than the abstract Tyler quotes.”

It is? Here’s the last two sentences from the end of the paper:

does a poor performance by the US health care system account for the low international ranking of longevity in the US? Our answer
is, “no†.

What is hedged about that answer to that question? That’s the question they were attempting to answer. The title of their paper is:

Low Life Expectancy in the United States: Is the Health Care System at Fault?

Is your argument that they asked the wrong question?

Stan August 10, 2009 at 3:48 pm

Does the paper mention who finances the health care of elderly people in the United States?

Steven Wicklund August 10, 2009 at 4:34 pm

I’d be more interested in a study of Obstetrics. This seems to be an area that well reflects US doctors focus on providing medical services, rather than focusing on good outcomes to pregnancy and birth. (Limiting interventions has shown better outcomes in Europe).

MPO August 10, 2009 at 4:57 pm

“Perhaps interestingly, they include data on breast cancer. Their charts show that the US has improved greatly, to the point that we now match the rest of the world.”

Maybe I’m extremely confused, but what is “the rest of the world,” and since when have we managed to finally catch and match them? The 1940s?

Rafe Furst August 10, 2009 at 7:32 pm

Riffing on “fusion”‘s first comment about faulty logic, I would have to agree. How can someone suggest that our health care system is not at fault when its entire modus operandi is based on finding ever more lucrative treatments to give people after they are already sick? Rather than, say, honoring the hard science which says that not only is it possible to prevent these diseases but that it’s way more cost effective to the patient (and also just plane more effective). And how is it not a failing of our health care system that a third or more of our population is so obese, diabetic, sedentary, etc in the first place?

Lord August 10, 2009 at 8:42 pm

They don’t really have anything to say about the uncovered. A comparison of 50-64 and 65+ would have helped, but the lack of much of a safety net may have more effect than medicine. It does seem the much greater spending here produces very meager results at best. If anything, the US may look overly good here if its betterment is simply due to standards and techniques that have not permeated as fast elsewhere. Their prostate cancer example seems to be a case of this.

Ricardo August 10, 2009 at 9:59 pm

Interesting but something doesn’t quite add up here:

1. This seems inconsistent with the analysis Ohsfeldt and Schneider have done that shows when controlling for fatal accidents and injuries, the U.S. looks much better in terms of life expectancy.

2. The statistic posted here a few days ago that the U.S. has a lower life expectancy at birth than the Netherlands but a higher life expectancy at age 65. Maybe this isn’t inconsistent if mortality in the U.S. is concentrated between 50 and 65 but it seems odd.

assman August 11, 2009 at 12:18 am

“The paper lists some diseases, shows rapid improvement of US outcomes for those diseases and concludes that low longevity ranking is not the result of the US healthcare system. This argument fails basic logic. That we’ve improved in some diseases shows nothing about the healthcare system in general.”

The argument of the paper is obvious. They are saying that if one want to compare outcomes of health systems which should look at the areas where health care has greatest impact. Those areas are areas like heart disease mortality reduction, cancer treatments blah. There are many things were health care systems have little impact (e.g. diabetes, incidence of heart disease, cancer etc) because they are chronic lifestyle type diseases. It makes absolutely no sense to blame a health care system for the incidence of diabetes, cancer or heart disease because these are lifestyle choices. It does make sense to examine the ability of the health care system to reduce mortality given that one has a disease.

The left never really separates these factors. There arguments make a lot of sense. You need to dis-aggregate factors outside the control of the health care system which cause increased mortality: obesity, no exercise, late pregnancies, high murder rate, irresponsibility, drug use, poverty etc. Whether they successfully do this or not that is another question.

Sonic Charmer August 11, 2009 at 1:16 am

The left never really separates these factors.

Heck, the left doesn’t even separate shootings and auto accidents as a factor. It’s just “life expectancy”. The real point is that actuarial “life expectancy” is a poor measure for anything outside of the life-insurance business, and (at least if not actually controlled for actual cause of death, etc) is not a good metric for health care.

Lord August 11, 2009 at 2:05 am

Probably the largest causes of these so-called ‘lifestyle’ diseases is stress, stress due to employment problems, stress due to poor safety nets, stress due to how we treat each other. Those may not be healthcare related, but they are societal. Those are the areas that need attention more than any.

Tracy W August 11, 2009 at 5:43 am

If life extension is merely improved, and at high cost in money and lifestyle, is the treatment really better?

Maybe.

And if life extension merely moved from four years to five years, is it really better?

Yes.

Andrew August 11, 2009 at 8:45 am

More definitions for progressives: When gov’t redistribution programs that run deficits (SS or Medicare) are popular that is democracy. When these programs go bankrupt that is market failure. When proposals for expanding these programs is found to be extremely unpopular, that is racism. When you identify and eliminate racism, that is progress.

Robin Hanson August 11, 2009 at 10:43 am

I worry that since we do more testing in this nation, we get more false positives, which then gives us a healthier pool of people who test as having these conditions, and so we get better outcomes from that pool.

Dr. T August 11, 2009 at 7:33 pm

fusion said: “The paper lists some diseases, shows rapid improvement of US outcomes for those diseases and concludes that low longevity ranking is not the result of the US healthcare system. This argument fails basic logic. That we’ve improved in some diseases shows nothing about the healthcare system in general.”

Fusion fails to realize that not every early death is due to a problem with health care. If someone fatally shoots me, my shortened life is due to violence, not bad medical care. If someone in a large SUV crosses the centerline and crushes my little Subaru, my shorted life is due to carelessness or accident, not bad medical care. You cannot use life expectancies to compare national health care systems unless you exclude homicides and accidental deaths.

Methinks August 11, 2009 at 8:17 pm

This incidence of these diseases are certainly the responsibility of health care…it’s called preventive medicine for a reason and there is a whole field of medicine devoted to it. but more importantly, the progression of the disease and it’s sequalae are most definitely the responsibility of health care.

Is that so? What you describe as “preventive medicine” is really preventive behaviours. No doctor came to these people’s houses and shoved french fries and milkshakes down their throats and no doctor could prevent them from doing it either.

The progress of the disease is only partially the responsibility of doctors. If the patient is non-compliant, there’s not much the doctor can do. I sat across the table from an uncontrolled type-II diabetic last week and watched her inhale caramel popcorn and cookies instead of the crab and salad the rest of us were eating. Is that her doctor’s fault?

John Dewey August 12, 2009 at 3:57 pm

Dr T: “No one said that life expectancy is the absolute determiner of health care system quality. But, the apples to oranges comparison is being used as ammunition for switching to a government-run system. Therefore, such unfair comparisons need to be contested.”

I completely agree. Our health care providers are not tasked with increasing life expectancy. Rather, they are paid enormous sums to treat sick and injured people – after those people become sick and injured.

Of course, many Democrats would wish for a health care “system” which would regulate lifestyles in the way they, the Democrats, wish life to be regulated. Expansion of the Medicare/Medicaid public option would provide them justification for increased control over lifestyles in the guise of controlling medical costs.

MHodak August 12, 2009 at 5:52 pm

I’m still waiting for the only study that will conclusively answer the relevant questions about life expectancy:

- How long do French-Americans live versus the French in France?
- How long do Swedish-Americans live versus Swedes in Sweden?
- What about Arab-Americans, African-Americans, etc.?

We already know the answer to one of these paired sets. Those Japanese who supposedly have the longest life expectancies on Earth? They don’t live as long as Japanese-Americans.

When we’ve got that canard retired, there will be no need to resort to excuses about lifestyle, diet, etc.

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