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Republican Senator John Ensign of Nevada said a couple of days ago that the US would have the best performance in terms of life-expectancy and health outcomes if we subtracted out the higher rate of violent death and accidents in the US compared to European countries.
A news clip I saw said that this claim is based on a study from awhile back, but I cannot find it, whatever it is or whoever did it. But in the mean time, we can look at some vital statistics to find out whether it is a reasonable claim.
First, let’s look at overall mortality rates. This is directly relevant to life-expectancy because the life-expectancy rates that are published by vital statistics agencies are really a way of summarizing mortality rates in a given year. So, let’s look at age and sex standardized mortality rates (per 100,000 population) for 22 high income countries, broken out by all causes, violent death and accidents (traffic accidents, falls, and assault), and non-violent causes (all cause mortality minus assault and accidents).
The countries are Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom and the United States. The data are for 2002, except 2001 for Canada and New Zealand. Mortality rates for Belgium are not included because it does not have enough recent data.
The average mortality rate in the US is 667, fourth highest among the 21 countries, behind the leader Denmark, and then Ireland and Portugal.
Now let’s look at violent death and falls. The US is second highest in traffic accidents (behind Portugal), twelfth (or middle of pack) in accidental falls, and first in assault. Overall, the US is fourth in violent death and accidents at 26, behind (again) Denmark, Ireland and Portugal.
The US mortality rate from non-violent causes is 640 (one death per 100k population is lost due to rounding). The US is fourth highest behind (you guessed it) Denmark, Ireland and Portugal. Assault, falls and traffic accidents do not seem to make much difference in the standings. The reason is that assault and accidents in high income countries make up only a small fraction of total mortality. The proportion ranges from a low of 1.5% in the UK, to a high of 4.0% in Italy. The difference in mortality rates between the US and leaders in life expectancy such as Japan, Switzerland, and Australia is between 140 and 200 deaths per 100,000 population, which is large compared to the mortality rate due to assault and accidents.
Of course it could be that most of the violence and accidents in the US takes place at very young ages, and if these deaths do occur at unusually young ages in the US compared to other countries, that might lower the life-expectancy at birth due to other causes enough to produce the best performance of all. For that to happen, the effect of very youthful death due to violence and accidents in the US would have to overcome its very high perinatal and infant mortality compared to other countries, and I think that is doubtful.
But there is another way to look at the problem, and that is to look at life-expectancies later in life, say at age 40 and 65. I think that is reasonable. Most assault occurs at younger ages. The US is middle of the pack of high income countries in the rate of mortality due to falls. That leaves traffic accidents, but most of those occur at younger ages.
At age 40, the life expectancy in for women in the US is tied for next to last with Ireland among 22 other high income countries in 2002 with a life expectancy 41.4 years. Only Denmark was worse.
At age 40, the life expectancy in for men in the US was tied for 16 with the Netherlands among 22 other high income countries in 2002 with a life expectancy 37 years
At age 65, the life-expectancy for men in the US is only about average out of 22 other high income countries. For women it is below average, ranked 15 out of 22 other high income countries.
I do not think that the high mortality rate due to traffic accidents, falls, and assault can explain the poor life-expectancies in the US compared to most other high income countries.
If anyone knows what report said that the US healthcare system had the best performance if you took out assaults, falls, and traffic accidents, please let me know in the commments. I would be interested in how they got to that conclusion.
Data from OECD health statistics 2007 and 2009
http://www.oecd.org/document/30/0,3343,en_2649_34631_12968734_1_1_1_37407,00.html
4 Comments
Not to worry–the ratio will soon be better now that you can bring firearms into Arizona saloons :) I don’t think Wyatt Earp would’ve been happy tho’.
While this is an interesting analysis it buys into the mistaken premise that the relevant data included violent death and auto accidents. The relevant study cited in the Senate Finance Committee debate is
This study was an analysis of amenable mortality. Amenable mortality is: ” deaths from conditions considered amenable to health care, such as treatable cancers, diabetes, and cardiovascular disease.” In other words, how many people died from disease that is not necessarilly fatal.
The data never included homicide or auto accidents. This was a analysis of the performance of medical systems rather than overall mortality and in the study the US comes in last.
Ok thanks. I saw a news clip with Ensign talking about assaults and accidents. There are several studies comparing amenable mortality across countries, the most recent one I know of is
Nolte E, McKee CM, Measuring the health of nations: updating an earlier analysis. Health Affairs (Millwood). 2008 Jan-Feb;27(1):58-71
There has been some debate about the amenable mortality issue. The claim of reform opponents is that this analysis depends on assumptions about what proportion of certain diseases are amenable to treatment, particularly heart disease and diabetes. Critics have shown that the estimates for amendable mortality in the US jump around a lot depending on the particular assumptions made on, for example, how much mortality due to heart disease in the US can be prevented by prevention and treatment.
The problem with that criticism is that the numbers for other countries jump around a lot too in the same direction depending on the assumptions, and the US always comes out last or very close to last no matter what assumptions you make on diseases where the results of prevention and treatment are uncertain. So, unless there is something very different about heat diseae and diabetes in the US versus other high income countries, the assumptions questioned by the crticd don’t make much differente in the results.
Interesting. When I was standing in line for my so-called Representative’s town hall meeting, two separate wingnuts out of the tiny handful present both made this claim, almost word for word.
I jus replied that, if that were so, it must be the lack of strict gun control in this country. Hee hee.