You've probably heard many times the oft-asserted claim that while the United States spends a staggering amount of money, both as total dollars and as a percentage of our GDP, on healthcare, our outcomes do not reflect this huge investment. Now comes a study in this week's JAMA providing data to back up this statement, as Rick and I lament on this week's PodMed.
Data from the Global Burden of Disease 2010 Study was used to compare health conditions and outcomes in the United States with those of the 34 countries comprising the Organisation for Economic Co-operation and Development (OECD) during the period from 1990 to 2010. Descriptive epidemiology of 291 diseases and injuries, over 1100 sequelae of those diseases and injuries, and 67 risk factors or clusters of risk factors was considered. Life expectancy during this period increased from 75. 2 years in 1990 to 78.2 years when both sexes were combined. Happily, the length of time someone could expect to live healthily also increased during this time period, from 65.8 years to 68.1 years. All cause mortality declined for all age groups, and age-specific rates of years lived with disability remained stable. Therein ends the good news.
What's the bad news? Morbidity and chronic disability account for half of the health burden in the United States, and improvements in population health have not kept pace with our fellow nations' improvements in same. What accounts for our health problems? The study identifies ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease and road injury as accounting for the majority of years of life lost, while years of life lived with disability were the result of low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. Disability-adjusted life years were most often related to dietary factors, cigarette smoking, high BMI, high blood pressure, high blood glucose, physical inactivity and alcohol use. No surprises here, but as the authors point out, important to identify and codify so that cogent policy can be formed going forward. Also worth noting, in our OECD cohort, we dropped from 18th to 27th for the age-standardized death rate.
The authors of this study point out an important separation between the causes of death in the study, our old friends cardiovascular disease, pulmonary disease and accidents, which have been the subject of intense intervention efforts for years and in fact, have been improved, and those that produce a couple years of misery and high healthcare costs at the end of a lifetime. These problems, such as musculoskeletal conditions and depression, are complex, often develop over time, and may be more resistant to interventions. Yet we must pay attention to them not just to keep health care costs under control but improve quality of life throughout a lifetime.
Other topics this week include limiting work week hours for interns in JAMA Surgery, variations in cardiac catheterization in Canada versus the US, and vitamin D levels and cardiovascular disease rates relative to ethnicity, last two in JAMA. Until next week, y'all live well.