American health equality is rising

by on November 28, 2017 at 2:41 am in Data Source, Medicine | Permalink

Recent research shows increasing inequality in mortality among middle-aged and older adults. But this is only part of the story. Inequality in mortality among young people has fallen dramatically in the United States converging to almost Canadian rates. Increases in public health insurance for U.S. children, beginning in the late 1980s, are likely to have contributed.

Here is the full article, by Janet M. Currie, via the excellent Kevin Lewis.

1 clockwork_prior November 28, 2017 at 3:35 am

This is bad news, right? Providing more health care, particularly to people who live longer, will bankrupt us – wasn’t that the MR belief du jour in essence?

Though the data would seem to contradict another MR touchstone, which is that health care has little to no impact on mortality.

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2 Anonymous November 28, 2017 at 4:10 am

It’s merely an opportunity to retrain all those retail and coal workers to become doctors. They will be obsoleted by automation otherwise, so it is win-win.

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3 Mr. America November 28, 2017 at 4:18 am

I stand for the flag.

I kneel at the cross.

Any questions?

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4 dearieme November 28, 2017 at 6:00 am

Is there other example of idolatry in which you indulge?

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5 Pshrnk November 28, 2017 at 10:03 am

What do you do for this?
w.pinmart.com/assets/1/19/DimRegular/9341.jpg?8226

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6 Pshrnk November 28, 2017 at 10:03 am
7 Tom T. November 28, 2017 at 8:16 am

The abstract as quoted here doesn’t appear actually to say that anyone is living longer — only that mortality rates between certain unspecified groups are converging.

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8 Albert November 28, 2017 at 8:44 am

The abstract clearly specifies which groups’ mortality rates are converging.

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9 Tom T. November 28, 2017 at 4:28 pm

Quote it for me, please. Mortality of which group of young people is converging with which other group?

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10 GoneWithTheWind November 28, 2017 at 10:16 am

The increase in mortality for middle age is mostly due to the increase in fentanyl use. The decrease in mortality rates for children is due to many things; Vaccinations, seat belts/child seats, reduced violent crime rates due to increased prison sentences for violent criminals, better safety standards for toys and playgrounds, etc.

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11 So Much For Subtlety November 28, 2017 at 4:40 am

The White working class is joining the African American population in one vast dysfunctional underclass. America is increasingly divided into those who get and stay married, go to college, work, don’t take drugs – and go to Church – on the one hand, and those who drink, take drugs, sleep around, have children without fathers and so on. Naturally the former group is going to live longer.

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12 clockwork_prior November 28, 2017 at 6:28 am

‘have children without fathers’

A rise in virgin births is occurring? Really?

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13 So Much For Subtlety November 28, 2017 at 6:47 am

So you think that “fatherhood” is defined by insemination alone? An interesting approach. Populations with many people that think so are going to be unhealthy almost by definition.

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14 clockwork_prior November 28, 2017 at 7:07 am

I guess it depends. Paternity is a legal definition of fatherhood, of course, and relevant in a court case. On the other hand, a child can certainly consider anyone ‘father,’ regardless of who agrees or disagrees with a child considering the man their mother marries after the child’s biological father died to be their ‘father,’ for example.

It is actually a subtle point, but it would be extremely surprising if the number of children without biological fathers is measurably different based on race, class, marital status, etc.

You might also want to consider the implications behind decade old reporting like this when it comes to accurately defining ‘fatherhood’ – ‘One in 25 fathers may not be the biological parent of the child they believe to be theirs, according to a study published today.

Its authors say governments and society have not woken up to how DNA testing and genetic profiling are lifting the lid on a “Pandora’s box” of hidden sexual behaviour or how the results might affect individuals, family relationships or public health.

Their review of estimates of so-called paternal discrepancy over more than 50 years suggests the father was not the natural parent in between 1% and 30% of cases.

The team from Liverpool John Moores University agreed that the figures, drawn from studies of men and women seeking proof of paternity, might be exaggerated because uncertainty over fatherhood is usually the reason for tests.

But other studies, such as those based on genetic health screening, might underestimate the level of mistaken fatherhood because people can refuse to participate or are excluded when paternity is in doubt.

Studies based on populations not being tested for paternity suggested a 3.7% rate, said the authors, but accurate figures were needed for Britain, where about a third of pregnancies are unplanned and one in five divorces cites infidelity by one or both partners.’ https://www.theguardian.com/society/2005/aug/11/childrensservices.uknews

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15 So Much For Subtlety November 28, 2017 at 9:38 am

So much blather – designed I assume to cover up the usual lack of any substantive point. Paternity is actually the legal definition of paternity. Not fatherhood. As everyone pretty much knows. Even before we got into the wonderful world of Gay parents and lesbians who have children.

“It is actually a subtle point, but it would be extremely surprising if the number of children without biological fathers is measurably different based on race, class, marital status, etc.”

And yet the evidence proves to the contrary. A lack of functional fathers is extremely common in African Americans and among the poor. Even more so among poor African Americans. It is rare among the middle class. As some people have noticed:

http://www.dailymail.co.uk/news/article-5114739/Denzel-Washington-lack-father-figures.html

“One in 25 fathers may not be the biological parent of the child they believe to be theirs, according to a study published today.”

Why would I want to consider such an obvious attempt to distract from the actual issues? However it just proves my point – someone who is legally the father but not the biological parent is in an interesting situation.

16 Pshrnk November 28, 2017 at 10:05 am

And apparently the rise in virgin births is among those who do not go to church!

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17 JonFraz November 28, 2017 at 1:05 pm

If “drugs” include alcohol I think you’ll find the more prosperous sorts enjoy an occasional cocktail too.

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18 Josh November 28, 2017 at 5:04 am

Probably the most racist thing I’ve read all day. I say probably because I follow Hitl..I mean Trump on twitter.

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19 dearieme November 28, 2017 at 6:01 am

That’s odd. It looks firmly anti-racist to me.

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20 lbc November 28, 2017 at 5:54 am

thank you obamacare

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21 clockwork_prior November 28, 2017 at 6:30 am

Well, Hellary can be just as easily blamed for this American health care catastrophe.

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22 Slocum November 28, 2017 at 8:07 am

“…starting in the 1980s”

I don’t know which is more amazing — that Obmacare, just a few years old, can be credited for changes starting the 1980s or that ‘Hillarycare’ (which, of course, never got off the ground) had such power back in the 90s.

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23 JWatts November 28, 2017 at 8:47 am

“thank you obamacare”

Well obviously Obama was so amazing that, not only did he stop the seas from rising, he also kicked off a national improvement in healthcare 30 years before he was President. Didn’t you ever watch Quantum Leap? Barack is like Scott Bakula, but way cooler.

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24 msgkings November 28, 2017 at 11:50 am

No one is cooler than Scott Bakula. How dare you?

25 JWatts November 28, 2017 at 1:49 pm

You could be quoting my mom with that comment, msgkings.

26 msgkings November 28, 2017 at 1:52 pm

LOL, well, your mom is a special lady, I tell her so every time.

27 JWatts November 28, 2017 at 2:11 pm

{chuckle}

28 Mulp November 28, 2017 at 10:45 am

Schip was the fallback Clinton healthcare initiative that covers half to a third of children under medicaid single payer. Reagan’s EMTALA is responsible for half of all births being Medicaid single payer.

In the 50s, vaccinations were often done in public school.

Today they are done in doctor offices with several times the number of vaccinations to attend school.

Medicaid covers a high percentage of children with working married parents who in the 50s would have been covered by employer health benefits.

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29 JonFraz November 28, 2017 at 1:08 pm

Re: Reagan’s EMTALA is responsible for half of all births being Medicaid single payer.

Huh? Did EMTLA extend Medicaid to children? First I’ve heard of it.

30 rayward November 28, 2017 at 6:54 am

So, the rate of mortality (that means death) among young people in America has improved so much that it’s almost at the level of Canada’s. I didn’t buy access to the linked article (so I don’t even know what the author means by “young people”), but here’s an article with charts from 2012: https://www.economist.com/blogs/graphicdetail/2012/04/daily-chart-14 What really sticks out (besides the overall high mortality rate in the U.S.) are the causes, with violence 18 times the rate in Britain. As one will also see from the charts, traffic accidents are the most common cause of mortality among young people in all countries shown on the charts, so I suspect that much of the improvement in mortality since 2012 has to do with a reduction in mortality caused by traffic accidents. Are we better drivers or are young people spending less time in vehicles?

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31 JWatts November 28, 2017 at 8:50 am

” Are we better drivers or are young people spending less time in vehicles?”

Well, if I were to think for a moment, I’d say it had more to do with: stricter DUI laws, seat belt laws, air bags, along with cars that are safer for the occupants during a crash, and various other safety features.

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32 rayward November 28, 2017 at 10:01 am

I’m pleased that there are readers of this blog who can “think for a moment”. Revelations have to come from somewhere.

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33 Todd K November 28, 2017 at 10:16 am

Can’t leave out cooler ambulances with more life saving equipment.

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34 msgkings November 28, 2017 at 11:53 am

Also young people really are driving less, that’s a pretty known meme especially on the coasts. Kids don’t get licenses or cars as early, using ride sharing a lot, and also it’s not just stricter DUI laws, the culture has changed. It’s a lot less cool to drive drunk, just like it’s a lot less cool to smoke cigarettes.

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35 JonFraz November 28, 2017 at 1:10 pm

Add in better road designs too, as we have gradually gotten rid of many hairpin curves, too-short exit ramps and merge lanes, blind intersections and other hazards.

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36 JWatts November 28, 2017 at 1:51 pm

There are a lot of good answers there. The only one that I’d have a hard time believing is that we are better drivers. Cell phones alone have made us all much worse.

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37 Floccina November 28, 2017 at 10:20 am

Are we better drivers or are young people spending less time in vehicles?

Yes and yes but also the cars are safer and better.

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38 rayward November 28, 2017 at 7:01 am

Since Cowen is impressed with rising equality in mortality among young people (does that mean more rich young people are dying or fewer poor young people are dying?), here’s the conclusion from a guest op/ed by Dani Rodrik on the Trump administration’s approach to trade agreements, in particular NAFTA, and how it likely affects inequality: “Mr. Trump’s failure to distance himself from special-interest globalization is perhaps not surprising. But it exposes the vacuity of his brand of populism. Despite all his talk about fairness and the need to stand up for ordinary working people, he has little to offer his core constituency. He will exacerbate, rather than mend, the grievances that made his presidency possible.” https://www.nytimes.com/2017/11/28/opinion/trump-trade-nafta.html

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39 Anonymous November 28, 2017 at 7:12 am

I post some retarded stuff but at least I keep it on topic.

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40 rayward November 28, 2017 at 7:42 am

Cowen framed the issue of mortality among young people as one of equality. And since Trump based his entire campaign on inequality produced by trade agreements, what issue relating to equality is more important than equality resulting from Trump’s approach to renegotiating said trade agreements. Duh.

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41 JWatts November 28, 2017 at 8:52 am

So just a partisan jab that’s tenuously connected with the topic eh?

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42 rayward November 28, 2017 at 9:57 am

Actually, in the op/ed Rodrik confirms what Trump alleges: “Mr. Trump is not wrong to think that trade agreements have shortchanged America as a whole while enriching corporate and financial interests. He was right to walk away from the Trans-Pacific Partnership, an agreement that was less about free trade and more about special privileges for investors, large companies and pharmaceutical businesses.”

43 TMC November 28, 2017 at 12:21 pm

Shorter Rayward: Yes.

44 Tom T. November 28, 2017 at 8:12 am

Inequality along which axis? Race? Ethnicity? Family income? I presume that the inequality in mortality based on gender remains as large and unremarked-upon as ever.

Which causes of death declined?

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45 Floccina November 28, 2017 at 9:53 am

How does this:

has fallen dramatically in the United States converging to almost Canadian rates

Square with this:

Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.

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46 Floccina November 28, 2017 at 9:59 am

BTW from an efficacy of spending perspective it seems to me like Government paying for the healthcare of the old (Medicare) is the opposite of what would be most effective, paying for the healthcare of those under 18 years old therfore, my assumption is that Medicare exists because the elderly vote more, but it could be that the elderly vote because of SS and Medicare. Did the elderly vote more than the non-elderly before SS and Medicare?

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47 TMC November 28, 2017 at 2:38 pm

There were a lot fewer of them. Likelihood of reaching 65 back then was small. Percentage doubled from the 50s to now.

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48 Floccina November 28, 2017 at 10:02 am

Also, more on topic, would a big part of that be because cars are getting safer and the murder rate is declining?

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49 Floccina November 28, 2017 at 10:05 am

Oh and BTW immigration from Latin America and Asia should also tend to push the youth death rate down.

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50 Tom T. November 28, 2017 at 4:25 pm

Up, I would think.

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51 collin November 28, 2017 at 9:56 am

Recent research shows increasing inequality in mortality among middle-aged and older adults. But this is only part of the story. Inequality in mortality among young people has fallen dramatically in the United States converging to almost Canadian rates. Increases in public health insurance for U.S. children, beginning in the late 1980s, are likely to have contributed.

When thinking about rising health inequality and death rates in the US, the most obvious thing I notice is the rising death rates are almost entirely in rural America. (Yes it the map looks a lot like the 2016 election with the highest Trump voting districts also having the shortening life spans but the correlation is rural America to both.) So I assume the big issue here is the access (and speed) of emergency healthcare that the lack of good facilities in rural America is diminishing the last couple decades.

1) How would you fix this problem?
2) Should Red Rural America Governors take more action here and what is that action?

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52 JWatts November 28, 2017 at 9:58 am

“So I assume the big issue here is the access (and speed) of emergency healthcare that the lack of good facilities in rural America is diminishing the last couple decades.”

I would assume it’s much more likely to be an aging and fatter rural America.

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53 Floccina November 28, 2017 at 10:25 am

I would assume that it has more to do with the current drug epidemic and it will pass.

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54 Tanturn November 28, 2017 at 10:51 am

Yep, it’s entirely due to the drug epidemic. Non-drug related mortality has continued to fall.

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55 Lanigram November 28, 2017 at 3:24 pm

I find it interesting nobody has mentioned the multiple links between economic growth, declining social capital, mental health, divorce, unemployment, substance abuse, mortality, and life expectancy.

I believe life expectancy has decreased and mortality increased for middle-aged white males in rural areas.

Talk to any recruiter or employment counselor and they will tell you it is unlikely an unemployed white male over the age of 50 is going to find any meaningful employment compared to what they had. Their new circumstances can lead to a cascade of negative events – financial stress, divorce, mental illness, and substance abuse – the death from despair downward spiral.

56 JWatts November 28, 2017 at 2:08 pm

“I would assume that it has more to do with the current drug epidemic and it will pass.”

Maybe, but is the much vaunted drug epidemic statistically insignificant.

According to this the total has been a rise in drug deaths from 18K to 64K in 17 years. That’s an alarming rise, but it’s statistically small.

https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

It’s an additional 46K deaths per year. There were 2.626 million deaths in 2016. Or 1.7%.

https://www.cdc.gov/nchs/fastats/deaths.htm

Meanwhile the Age-adjusted death rate continues it’s steady and very long running decline.
https://www.cdc.gov/nchs/data/databriefs/db88.htm#

Frankly the whole America’s quality of health care is rapidly declining seems to be a myth. It’s not even stagnating. It’s continuously getting better. You’ll note there was a stagnation from 1955 to 1970.

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57 Floccina November 29, 2017 at 5:14 pm

According to this the total has been a rise in drug deaths from 18K to 64K in 17 years. That’s an alarming rise, but it’s statistically small.

But people can die young due to drug overdoses. If life expectancy is 78 and a guy dies at 38 you have to have 4 people live to 88 to make up for that one death.

58 Harun November 28, 2017 at 3:01 pm

First of all, we know that only the Federal government can address inequality.

And we’ll need to redistribute resources to achieve this.

Really, if we oculd just convince more people to move to rural areas, it would create a natural demand for better health services.

A simple financial incentive for city folks to move would work. Say, some 10% special tax on those who work in cities above X% of density?

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59 Punctuation = intelligence November 28, 2017 at 1:12 pm

The lack of a comma in the abstract’s key sentence, between “United States” and “converging,” is so startling — such a glaring failure of basic English punctuation — that, at least for me, it casts doubt on everything else the article has to say.

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60 msgkings November 28, 2017 at 1:17 pm

Yes it is very upsetting, I actually cried out when I read it. Shocked my co-workers.

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61 TMC November 28, 2017 at 2:40 pm

“Shocked my co-workers.” That caused a lol for sure.

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62 Jimbino November 28, 2017 at 2:17 pm

Insurance, like Obamacare with its 80% ” loss-ratio,” raises the cost of a medical procedure or a drug 25%. If you couldn’t afford to pay for health care before, you surely can’t afford the insurance to pay for it now.

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63 Jimbino November 28, 2017 at 2:17 pm

Insurance, like Obamacare with its 80% ” loss-ratio,” raises the cost of a medical procedure or a drug 25%. If you couldn’t afford to pay for health care before, you surely can’t afford the insurance to pay for it now.

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64 Lanigram November 28, 2017 at 3:30 pm

I often wonder how healthcare prices would respond if we paid cash for them. In that scenario we would be looking for the best deal. If I had “auto purchase insurance” with a $25,000 deductable I would get the Ferrari.

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65 msgkings November 28, 2017 at 3:47 pm

Kind of hard to look for the best deal in an emergency. But yes more listed prices and incentives to shop around for non-emergency services would help. So would increased supply such as letting nurses and clinics do the basics: shots, prescriptions, etc.

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