BACKGROUND AND PURPOSE:

• US had higher per capita spending on healthcare vs any other developed country at $9491 per capita (2015 data)
• Emanuel et al. (JAMA Intern Med, 2020) assessed whether health outcomes of White US citizens living in the 1% and 5% richest counties are better than the health outcomes of average residents in other developed countries

METHODS:

• Comparative effectiveness study
• Participants
  • White US citizens living in either
    • The 1% highest-income counties in the US (n = 32)
    • The 5% highest-income counties in the US (n = 157)
  • All residents in 12 other developed countries
• Study Design
  • Compared US outcomes with data from Australia, Austria, Canada, Denmark, Finland, France, Germany, Japan, the Netherlands, Norway, Sweden, and Switzerland
• Primary outcomes
  • Infant and maternal mortality
  • 5-year survival of colon and breast cancer patients
  • 5-year survival of childhood acute lymphocytic leukemia patients
  • 30-day age-standardized case fatality after acute myocardial infarction (AMI)

RESULTS:

• Infant and maternal mortality in 5% highest-income counties
  • Infant mortality rate: 4.01 per 1000
  • Maternal mortality rate: 10.85 per 1000
  • Both higher than the mean rates for any of the comparison countries
  • Even for highest 1% highest-income counties, maternal mortality is still higher
• 5-year survival rates for colon cancer in the 5% highest-income counties was 67.2% (95% CI, 66.7 to 67.7%)
  • Higher than rates for average US citizens and average citizens of 6 countries
  • Comparable to rates for average citizens in 4 countries
  • Lower than rates for average citizens in 2 countries
• 5-year survival rates for breast cancer were in the 5% highest-income counties was 92.0% (95% CI, 91.6 to 92.4%)
  • Higher than rates for average citizens in all 12 comparison countries
• Among white children in the 5% highest-income counties, 5-year survival rates with acute lymphocytic leukemia was 92.6% (95% CI 90.7 to 94.2%)
  • Higher than the average rate in 1 country
  • Comparable to the average rate in 11 countries
• Adjusted 30-day AMI case-fatality rate in the 5% highest-income counties was
  • 8% below the rate for all US citizens
  • 5% below the rate for US citizens in the 1% highest-income US counties
  • Estimates were comparable to the median outcome of other high-income countries

CONCLUSION:

• White US citizens in the high-income counties often have better health outcomes than the average health outcomes of US citizens
• However, wealthier White US citizens may have worse health outcomes than average citizens of other developed countries
• Breast cancer survival is better in the US, but that may be related to increased mammography screening programs which will pick up tumors at an earlier stage but may not necessarily alter mortality rates
• The authors conclude that for White citizens in wealthier US counties

…in general, the outcomes for these individuals are no better than for average citizens in many other developed countries, and for infant, maternal, and AMI mortality, privileged White US citizens often fare worse

Learn More – Primary Sources:

Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries

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