Tuesday, August 28, 2007

Another Royal Fisking (Mortality v Morbidity)

UPDATE & BUMP: Please see the important update at the end of this post.
Recently, the results of a new study has been making its way around the medblogosphere, with predictable results: our broken, run-down, leaky, smelly health care system has led us to rank 42nd (internationally) in life expectancy.
Quick, someone get me an umbrella: the sky is falling!
Um, no:
Contrary to the headlines ("Lack of insurance, obesity, racial disparities to blame"), the mortality rate is not the same as the morbidity rate. The former addresses the number of deaths in a given population, while the latter reflects its health (or lack thereof). While they are, of course, related, correlation is not causation.
My favorite quote comes from Dr. Christopher Murray, of the University of Washington:
Something’s wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries,” he sanctimoniously opines.
How many illegal (and often unhealthy) aliens are clamoring at the borders of Guam, Japan or Italy? (Clamoring to get in, that is) Think our burgeoning population of such folks might have some effect on our national health care, and mortality, picture?
And that's really the point: we'd need a lot more information to tell how much, if anything, the life expectancy numbers have to do with quality of health care. For example, we learn from the CDC that 75 % "of the more than 40,000 deaths each year among persons aged 10-24 years in the United States are related to preventable causes such as motor-vehicle crashes (37%), homicide (14%), suicide (12%), and other injuries (e.g., drowning, poisoning, and burns) (12%). " That's not a reflection on our health care system, but on our priorities and culture.
Need more proof? No problem:
Again according to the CDC, heart disease and cancer account for almost half of all deaths in the US. But how, exactly, does that indict the health care system? We spend enormous sums in research and treatment of these conditions, but if folks won't stop smoking, and start excercising and eating a more healthful diet [ed: hey, you talkin' to me?!], there's precious little that "the system" can do about it.
And he agrees with my arguments about lifestyle choices, as well:
"Diet and lack of exercise also bring down average life expectancy."
Finally, and this is the one that always frosts me, the authors drag out the oft-repeated (and always debunked) canard about our "sky high infant mortality rate." Truth is, the leading cause of infant mortality in the U.S. is "congenital malformations, deformations and chromosomal abnormalities." There's no evidence that our doc's are less capable of dealing with these than physicians in other countries.
More importantly, though, is the statistical sleight of hand that proponents of this myth like to pull. That is, citing infant mortality numbers without proper context: in many countries (even "developed" ones), infants with severe or fatal conditions aren't even counted as live births (or are aborted when diagnosed), whereas we do everything we can to save such innocents. One may argue the efficacy of such an attitude, but we value life.
Case closed.
UPDATE: While we're on the subject of mortality and morbidity, and specifically discussing how health care affects either one (if at all), perhaps some current, updated info may be of value:
Indeed, despite the fact that the "much vaunted NHS" spends more than three times more on health care than Poland, the Polish cancer mortality rate is almost the same as Britain's.
So for cancer, at least, increased health care spending does not translate to better health care outcomes.
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