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1989-2015 年美国、英国和其他西方国家的死亡率:美国出了什么问题?

Mortality in the USA, the UK and Other Western Countries, 1989-2015: What Is Wrong With the US?

机构信息

Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.

出版信息

Int J Health Serv. 2021 Jan;51(1):59-66. doi: 10.1177/0020731420965130. Epub 2020 Oct 15.

Abstract

This population-based study compares U.S. effectiveness with 20 Other Western Countries (OWC) in reducing mortality 1989-1991 and 2013-2015 and, responding to criticisms of Britain's National Health Service, directly compares U.S. with U.K. child (0-4), adult (55-74), and 24 global mortality categories. World Health Organization Age-Standardized Death Rates (ASDR) data are used to compare American and OWC mortality over the period, juxtaposed against national average percentages of Gross Domestic Product (GDP) Expenditure on Health (%GDPEH) drawn from World Bank data. America's average %GDPEH was highest at 13.53% and Britain's the lowest at 7.68%. Every OWC had significantly greater ASDR reductions than America. Current U.S. child and adult mortality rates are 46% and 19% higher than Britain's. Of 24 global diagnostic mortalities, America had 16 higher rates than Britain, notably for Circulatory Disease (24%), Endocrine Disorders (70%), External Deaths (53%), Genitourinary (44%), Infectious Disease (65%), and Perinatal Deaths (34%). Conversely, U.S. rates were than Britain's for Neoplasms (11%), Respiratory (12%), and Digestive Disorder Deaths (11%). However, had America matched the United Kingdom's ASDR, there would have been 488,453 fewer U.S. deaths. In view of American %GDPHE and their mortality rates, which were significantly higher than those of the OWC, these results suggests that the U.S. health care system is the least efficient in the Western world.

摘要

这项基于人群的研究比较了美国与其他 20 个西方国家(OWC)在降低 1989-1991 年和 2013-2015 年死亡率方面的效果,并针对英国国民保健制度(NHS)所受到的批评,直接将美国与英国在儿童(0-4 岁)、成人(55-74 岁)和 24 个全球死亡率类别方面进行了比较。研究使用了世界卫生组织(WHO)年龄标准化死亡率(ASDR)数据,比较了美国和 OWC 在整个时期的死亡率,并与世界银行(World Bank)数据中各国国内生产总值(GDP)用于医疗保健的平均百分比(%GDPEH)并列。美国的平均%GDPEH 最高,为 13.53%,而英国最低,为 7.68%。每个 OWC 的 ASDR 降幅都明显高于美国。当前美国儿童和成人的死亡率比英国分别高出 46%和 19%。在 24 种全球诊断性死因中,美国有 16 种的死亡率高于英国,特别是循环系统疾病(24%)、内分泌失调(70%)、外部死亡(53%)、泌尿生殖系统(44%)、传染病(65%)和围产期死亡(34%)。相反,美国的肿瘤(11%)、呼吸系统(12%)和消化系统疾病死亡率(11%)则低于英国。然而,如果美国的 ASDR 与英国相同,那么美国的死亡人数将减少 488,453 人。鉴于美国的%GDPHE 和死亡率都明显高于 OWC,这些结果表明,美国的医疗保健系统在西方世界是效率最低的。

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