The US Health Disadvantage Relative to Other High-Income Countries

Woolf, Steven H.; Aron, Laudan

doi:10.1001/jama.2013.91

Cited by 92 publications

(53 citation statements)

References 4 publications

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“…Comparative research strongly suggests that the root causes of premature mortality in the USA relate to its poor performance in tackling the social determinants of health (Woolf & Aron, 2013) A recent extensive review of mortality in Scotland also suggests that the lasting effects of deindustrialisation, deprivation and higher inequality have resulted in it experiencing an excess of 5000 deaths per year (Walsh et al, 2016). These are all important social determinants of health and mortality which social and economic policies can alleviate (Bambra, 2011, Coburn, 2000, McCartney et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Increasing inequality in age of death at shared levels of life expectancy: A comparative study of Scotland and England and Wales

Seaman

Leyland

Popham

2016

SSM - Population Health

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There is a strong negative correlation between increasing life expectancy and decreasing lifespan variation, a measure of inequality. Previous research suggests that countries achieving a high level of life expectancy later in time generally do so with lower lifespan variation than forerunner countries. This may be because they are able to capitalise on lessons already learnt. However, a few countries achieve a high level of life expectancy later in time with higher inequality. Scotland appears to be such a country and presents an interesting case study because it previously experienced lower inequality when reaching the same level of life expectancy as its closest comparator England and Wales. We calculated life expectancy and lifespan variation for Scotland and England and Wales for the years 1950 to 2012, comparing Scotland to England and Wales when it reached the same level of life expectancy later on in time, and assessed the difference in the level of lifespan variation. The lifespan variation difference between the two countries was then decomposed into age-specific components. Analysis was carried out for males and females separately. Since the 1950s Scotland has achieved the same level of life expectancy at least ten years later in time than England and Wales. Initially it did so with lower lifespan variation. Following the 1980s Scotland has been achieving the same level of life expectancy later in time than England and Wales and with higher inequality, particularly for males. Decomposition revealed that higher inequality is partly explained by lower older age mortality rates but primarily by higher premature adult age mortality rates when life expectancy is the same. Existing studies suggest that premature adult mortality rates are strongly associated with the social determinants of health and may be amenable to social and economic policies. So addressing these policy areas may have benefits for both inequality and population health in Scotland.

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Section: Discussionmentioning

confidence: 99%

Increasing inequality in age of death at shared levels of life expectancy: A comparative study of Scotland and England and Wales

Seaman

Leyland

Popham

2016

SSM - Population Health

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“…A recent set of analyses from the National Academies of Sciences suggests that the United States is falling behind other wealthy countries in the rate of life expectancy increases 21 . Of particular interest was the observation that deaths early in the life cycle, particularly before age 50, explain an important part of the variance in this relative decline in American health.…”

Section: Discussionmentioning

confidence: 99%

Educational attainment and longevity: results from the REGARDS U.S. national cohort study of blacks and whites

Kaplan

Howard

Safford

et al. 2015

Annals of Epidemiology

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Background Educational attainment may be an important determinant of life expectancy. However, few studies have prospectively evaluated the relationship between educational attainment and life expectancy using adjustments for other social, behavioral, and biological factors. Method The data were from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study that enrolled 30,239 black and white adults (45 years of age and older) between 2003 and 2007. Demographic and cardiovascular risk information is collected and participants are followed for health outcomes. Educational attainment was categorized as less than high school education, high school graduate, some college, or college graduate. Proportional hazards analysis was used to characterize survival by level of education. Results Educational attainment and follow-up data were available on 29,657 (98%) of the participants. Over 6.3 years of follow up, 3,673 participants died. There was a monotonically increasing risk of death with lower levels of educational attainment. The same monotonic relationship held with adjustments for age, race, sex, cardiovascular risk factors and health behaviors. The unadjusted hazard ratio for those without a high school education in comparison to college graduates was 2.89 (95% CI=2.64–3.18). Although adjustment for income, health behaviors, and cardiovascular risk factors attenuated the relationship, the same consistent pattern was observed after adjustment. The relationship between educational attainment and longevity was similar for black and for white participants. The monotonic relationship between educational attainment and longevity was observed for all age groups, except for those 85 years or older. Conclusions Educational attainment is a significant predictor of longevity. Other factors, including age, race, income, health behaviors, and cardiovascular risk factors only partially explain the relationship.

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“…Tables 2 through 7 provide a comprehensive and detailed description of both the scope and breadth of the challenges, opportunities, and resources needed for conducting communityengaged implementation research to reduce cardiovascular disparities. Potential solutions for NHLBI to consider fall within 4 overlapping domains: (1) support of true community-based, community-participatory implementation research projects; (2) strategies to advance innovative improvements in care delivery within health systems; (3) strategies that address the social determinants of health and structural changes in the built environment in communities; and (4) training a diverse workforce appropriate to the regional populations and skilled in the reduction of cardiovascular disparities in strategic partnerships with community by guest on May 12, 2018 http://circres.ahajournals.org/ Downloaded from stakeholders. A detailed list of specific examples from these domains with enough granularity appropriate for different communities is beyond the scope of this workshop report; however, at the general level, these potential solutions focus on 1. supporting highly meritorious community-engaged implementation research initiatives; 2. harnessing cutting-edge information sources and analytic methods to identify high-burden communities that are receptive to change; 3. supporting enduring and effective community-engagement policies and practices; 4. developing and testing models for integration and delivery of evidence-based interventions; 5. nurturing innovative efforts to align community-based organizations, public health agencies, and healthcare systems; 6. identifying, vetting, and promoting the use of appropriate methods and metrics for study conduct and evaluation; 7. implementing scalable approaches for training the needed current and future generations of the workforce; and 8. supporting the development of strategic partnerships between research investigators, their institutions and centers, and community stakeholders.…”

Section: Importance Of Strategic Collaborationsmentioning

confidence: 99%

“…4 Despite this progress, blacks <65 years old and several population groups and communities continue to demonstrate marked cardiovascular disparities, and in some settings, the disparities are widening. [4][5][6][7][8][9][10][11][12] These disparities arise from differences in major cardiovascular risk factors and causes of death and disability that are preventable [1][2][3]13 and are seen in all stages of the life course beginning in the intrauterine environment 14,15 and early childhood [16][17][18] through young adulthood [19][20][21] and old age. [22][23][24] In addition, social determinants of health, such as low socioeconomic status (SES), stress, poor social support, depression, anxiety, and living in disadvantaged neighborhoods, contribute to cardiovascular disparities.…”

mentioning

confidence: 99%

Reducing Cardiovascular Disparities Through Community-Engaged Implementation Research

Mensah

Cooper

Siega‐Riz

et al. 2018

Circulation Research

111

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Cardiovascular disparities remain pervasive in the United States. Unequal disease burden is evident among population groups based on sex, race, ethnicity, socioeconomic status, educational attainment, nativity, or geography. Despite the significant declines in cardiovascular disease mortality rates in all demographic groups during the last 50 years, large disparities remain by sex, race, ethnicity, and geography. Recent data from modeling studies, linked micromap plots, and small-area analyses also demonstrate prominent variation in cardiovascular disease mortality rates across states and counties, with an especially high disease burden in the southeastern United States and Appalachia. Despite these continued disparities, few large-scale intervention studies have been conducted in these high-burden populations to examine the feasibility of reducing or eliminating cardiovascular disparities. To address this challenge, on June 22 and 23, 2017, the National Heart, Lung, and Blood Institute convened experts from a broad range of biomedical, behavioral, environmental, implementation, and social science backgrounds to summarize the current state of knowledge of cardiovascular disease disparities and propose intervention strategies aligned with the National Heart, Lung, and Blood Institute mission. This report presents the themes, challenges, opportunities, available resources, and recommended actions discussed at the workshop. (Circ Res. 2018;122:213-230.

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The US Health Disadvantage Relative to Other High-Income Countries

Cited by 92 publications

References 4 publications

Increasing inequality in age of death at shared levels of life expectancy: A comparative study of Scotland and England and Wales

Increasing inequality in age of death at shared levels of life expectancy: A comparative study of Scotland and England and Wales

Educational attainment and longevity: results from the REGARDS U.S. national cohort study of blacks and whites

Reducing Cardiovascular Disparities Through Community-Engaged Implementation Research

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