Buxbaum Jason D, Chernew Michael E, Fendrick A Mark, Cutler David M
Jason D. Buxbaum (
Michael E. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation (HMR) Lab in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts.
Health Aff (Millwood). 2020 Sep;39(9):1546-1556. doi: 10.1377/hlthaff.2020.00284.
Life expectancy in the US increased 3.3 years between 1990 and 2015, but the drivers of this increase are not well understood. We used vital statistics data and cause-deletion analysis to identify the conditions most responsible for changing life expectancy and quantified how public health, pharmaceuticals, other (nonpharmaceutical) medical care, and other/unknown factors contributed to the improvement. We found that twelve conditions most responsible for changing life expectancy explained 2.9 years of net improvement (85 percent of the total). Ischemic heart disease was the largest positive contributor to life expectancy, and accidental poisoning or drug overdose was the largest negative contributor. Forty-four percent of improved life expectancy was attributable to public health, 35 percent was attributable to pharmaceuticals, 13 percent was attributable to other medical care, and -7 percent was attributable to other/unknown factors. Our findings emphasize the crucial role of public health advances, as well as pharmaceutical innovation, in explaining improving life expectancy.
1990年至2015年间，美国的预期寿命增加了3.3岁，但人们对这一增长的驱动因素了解并不充分。我们利用人口动态统计数据和病因剔除分析，来确定对预期寿命变化负有最大责任的疾病，并量化公共卫生、药物、其他（非药物）医疗护理以及其他/未知因素对预期寿命改善的贡献。我们发现，对预期寿命变化负有最大责任的12种疾病解释了2.9岁的净增长（占总增长的85%）。缺血性心脏病是预期寿命增长的最大正向贡献因素，意外中毒或药物过量是最大的负向贡献因素。预期寿命改善的44%归因于公共卫生，35%归因于药物，13%归因于其他医疗护理，-7%归因于其他/未知因素。我们的研究结果强调了公共卫生进步以及药物创新在解释预期寿命改善方面的关键作用。
