November 03, 2010
Unhealthier Americans Live As Long As Healthier Brits

Ever come across simplistic commentators who compare health care systems by comparing life expectancies? Most annoying. Many factors determine life expectancy aside from health care systems. Diets, exercise, even weather influence life expectancy. The need to control for these other factors make well done health care system performance comparisons non-trivial. The RAND Corp has taken an interesting approach to comparison of two health care systems: Older Americans who have more chronic diseases than similar aged older English live just as long as their English counterparts on average. This probably shows the higher amount of money spent per American patient really is buying life expectancy benefits.

Older Americans are less healthy than their English counterparts, but they live as long or even longer than their English peers, according to a new study by researchers from the RAND Corporation and the Institute for Fiscal Studies in London.

Researchers found that while Americans aged 55 to 64 have higher rates of chronic diseases than their peers in England, they died at about the same rate. And Americans age 65 and older -- while still sicker than their English peers -- had a lower death rate than similar people in England, according to findings published in the journal Demography.

The paper was co-authored by James Banks and Alastair Muriel of the Institute for Fiscal Studies and James P. Smith, distinguished chair in labor markets and demographic studies at RAND.

What I take away from this: If you want to maximize your life expectancy while waiting for rejuvenation therapies then choose a diet and lifestyle that will make your risk of chronic illnesses even lower than chronic disease rates in England and make sure you can afford the very best medical care. Given an ideal diet (i.e. a diet that is probably better than what you eat now), exercise, low exposure to pollutants, and other health-promoting practices you can delay the onset of chronic diseases. Then once they hit you can use cash and an excellent nearby research hospital (and, yes, quality of care varies considerably) to further delay the grim reaper.

Better to be sick in America.

"If you get sick at older ages, you will die sooner in England than in the United States," Smith said. "It appears that at least in terms of survival at older ages with chronic disease, the medical system in the United States may be better than the system in England."

The study expands upon an earlier analysis by Banks and Smith that found that Americans aged 55 to 64 suffered from diseases such as diabetes at rates up to twice those seen among similarly aged people in England. The trend was observed across all socioeconomic groups.

The American health care system (really an assortment of systems) is expensive. But it delivers a number of benefits. One is mentioned above: It does a better job of managing and treating chronic diseases of old age. But that's not all. It also does not make people wait as long. A person who has, say, a bad hip who has to wait for months to get it fixed loses work (which costs both the individual and the government money) and experiences a lot of pain while waiting. The queues that are characteristic of cheaper health care systems impose costs on customers/supplicants.

My favorite advantage of the American health care system is that it presents huge incentives to the market for the development of newer and better treatments. That's what makes the biggest difference to most of us in the long run. If you are many years away from your first life-threatening illness then the speed or thoroughness with which the current health care system treats you is less important than what future treatments it will offer you 10, 20, 30 or more years from now. I favor a health care system that offers huge incentives for new treatments and low barriers to entry for those treatments.

Share |      Randall Parker, 2010 November 03 10:27 PM  Policy Medical

random said at November 4, 2010 10:52 AM:

Which system is better at preventing/curing chronic diseases in the elderly? Frankly I've seen too many people "surviving" in old age in such poor physical or mental condition that most people would choose death first. Life expectancy is not the whole story.

Dave in Seattle said at November 5, 2010 12:08 PM:

That's the advantage of living at a lower latitude. Sunshine makes Vitamin D and Vitamin D prevents cancer. By setting the recommended daily allowance to a very low level the United States government contributed to the deaths of millions.

TangoMan said at November 5, 2010 9:28 PM:

What I take away from this study is the researchers didn't properly control for confounds. The racial differences between the US and the UK are noticeable and become even more noticeable when the sample size of the populations is restricted to those who are 55-64 and 70-80.

First off, when comparing the two groups we need to recognize that disease, and severity of disease, often has disparate impact between racial groups. Types and severity of breast cancer, stroke, heart disease, all show racial disparity. So, to some degree, this will show up in the aggregated statistics for the US population. We are, as a nation, less healthy but what utility is there is looking at national statistics if the international comparisons are useless because of population genetic variance?

The study expands upon an earlier analysis by Banks and Smith that found that Americans aged 55 to 64 suffered from diseases such as diabetes at rates up to twice those seen among similarly aged people in England. The trend was observed across all socioeconomic groups.

Take a look at the incidences rates for diabetes in some American subpopulations:

African Americans are twice as likely to be diagnosed with diabetes as non-Hispanic whites. In addition, they are more likely to suffer complications from diabetes, such as end-stage renal disease and lower extremity amputations
The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world. On average, American Indian and Alaska Native adults are 2.6 times more likely to have diabetes than non-Hispanic whites of similar age.
According to a national examination survey, Mexican Americans are almost twice as likely as non-Hispanic whites to be diagnosed with diabetes by a physician. They have higher rates of end-stage renal disease, caused by diabetes, and they are 50% more likely to die from diabetes as non-Hispanic whites.

I'm not arguing that what the researches have discovered is merely an artifact of confounds, rather my point is that they haven't rule out the effects of confounds.

Diabetes rates were almost twice as high in the United States as in England (17.2 percent versus 10.4 percent)

Let's just do a rough calculation to examine the effect of race on the aggregate measure. Let's assume that at those age groups, the US racial mix is 75% white and 25% non-white, comprised of blacks, natives and mestizo Hispanics. Let's also assume a uniform rate for the non-white group at twice the white group.

17.4% = 0.75(American incidence rates for whites) + 0.25(American incidence rate for non-whites)
17.4% = 0.75(13.92%) + 0.25(27.84%)

With a rough control added, we see the variance between the UK (whites) and the US (whites) falling from 17.2% v. 10.4% to 13.92% v. 10.4%. If the UK whites and the US whites represented the same genetic population substructure, which they do not, then we would have controlled for genetics and we'd be looking at a 3.5 percentage point difference in diabetes rates between the two population groups which we could postulate was due to environmental factors. However, the researchers didn't do any sort of control for race and simply attributed variance to environment.

In spite of both higher prevalence and incidence of disease in America, death rates among Americans were about the same in the younger ages in this period of life and actually lower at older ages compared to the English.

If the death rates are the same for the UK and the US yet a subpopulation of the American group is experiencing higher rates of death for diabetes, for example, then it follows that different subpopulations are experiencing a lower rate of death than the population of the UK.

Their second conclusion, that Americans have a lower death rate than the UK population follows, to some undetermined degree, from the first conclusion, in that as some American subpopulations die at younger ages, the subpopulation mix for a disease will change for the combined populations at later stages of life. Some of the remaining subpopulations actually had lower death rates than the UK population,so as their prominence in the American population mix increses, the aggregate American death rate will move below the UK death rate.

Researchers say there are two possible explanations why death rates are higher for English after age 65 as compared to Americans. One is that the illnesses studied result in higher mortality in England than in the United States. The second is that the English are diagnosed at a later stage in the disease process than Americans.

I've just provided a third explanation. Their second explanation doesn't account for the US observation that many minorities who are affected with various forms of chronic disease also tend to be diagnosed later.

"Both of these explanations imply that there is higher-quality medical care in the United States than in England, at least in the sense that these chronic illnesses are less likely to cause death among people living in the United States," Smith said.

That may be likely, but this study is too riddled with confounds and so this conclusion isn't supported.

LAG said at November 6, 2010 11:35 AM:

"Better to be sick in America." Well, only until O-care kicks into top gear. Then you'll have all the 'benefits' of English health care with American chronic conditions.

Randall Parker said at November 7, 2010 7:02 AM:


But above the age of 60 the ratio of whites to non-whites in the US is far higher. Therefore my guess is that the racial confounds are not as big a factor as your rough calc suggests. Though you still make a good point.

Joseph Hertzlinger said at November 7, 2010 10:28 PM:

A system in which a diagnosis of chronic illness means they must pay more will diagnose fewer such illnesses than a system in which a diagnosis of chronic illness means they will be paid more.

LAG said at November 9, 2010 7:57 PM:

John, why is it that people who believe that government, on one day, can over-react, conspire, and abuse its citizens, can on the next day be entrusted with overseeing (or making) their most important decisions?

Here's a little example: "The Orlando Sentinel reports that the Orange County (Florida) Sheriff’s Office has been enforcing Florida’s barber licensing requirements in an unusually aggressive way: conducting armed raids of barbershops, handcuffing barbers while their records are checked, and searching (without warrants) for drugs and other contraband."

Barbershops? Armed raids? Is this okay with you?

Personally, I'm not in favor at anytime of government direction of my life.

Bryan Bolea said at November 10, 2010 8:35 PM:

"And Americans age 65 and older -- while still sicker than their English peers -- had a lower death rate than similar people in England," What am I missing here? This is only 1/2 tongue-in-cheek - aren't all the folks 65 and over going to die? Unless the researchers put an upper limit on this range, or only looked at a particular segment of time, wouldn't the death rates have to be pretty equal? And, no tongue-in-cheek, is death-rate really the variable we ought to be concerned with? Given the choice, who among us wouldn't choose a healthy active 65 year life span over an 80 year life expectancy with the last 20-30 in miserable shape?

Suburbanbanshee said at November 15, 2010 6:29 AM:

I can't tell you how many times that sf fans in the US would hear about some illness that a UK sf fan's parent was experiencing. They would immediately be shocked that the UK dad or mom hadn't been able to see a doctor yet, or get serious treatment yet, or was on a list for surgery that would take place months and months in the future. Again and again, US fans would urge the UK people to take their parents to a private doctor in the UK, or even to bring them with them on trips to US conventions. (Various fan organizations even offered to bring the parents over for free, particularly fans in Boston, who expect super medical care.) Again and again, it would be explained that the parents didn't want to be seen as cheating by "jumping the queue" or to take any kind of charity. And again and again, the parent would die in agony from some preventable cause, and then we would hear that the body was on the queue to be autopsied so the funeral wouldn't be for months yet. It's a horrible thing.

The NHS is fine, as long as you don't have anything serious. If you do, it's a deathtrap.

However, I'm sure the overall deathrate is accelerated by WWII conditions, and by post-WWII rationing and austerity.

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