Departments of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice and Medicine, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
J Urban Health. 2021 Oct;98(5):665-675. doi: 10.1007/s11524-021-00516-3. Epub 2021 Mar 24.
The USA leads the world in healthcare spending but trails dozens of countries in life expectancy. Government spending may reduce overall mortality by redistributing resources from the rich to the poor. We linked mortality data from 2006 to 2015 to municipal and state government spending in 149 of the largest American cities. We modeled the association of mortality with city and state government spending per capita in 2005 using weighted linear regression. A 10% increase in state government expenditures was associated (P = 0.008) with a 1.4% (95%CI: 0.4-2.4%) reduction in mortality in American cities. Total city government expenditures were not associated with mortality (P > 0.10). However, among Whites, increases in city government spending were associated with a reduction in mortality of 4.8% (2.1-7.5%), but among Blacks and Asians, increased city government spending was associated with respective mortality increases of 1.7% (0.6-2.9%) and 5.1% (2.1-6.2%). State government spending is associated with reduced mortality in American cities. City government spending appears to benefit White longevity and hurt non-White longevity.
美国在医疗保健支出方面处于世界领先地位，但在预期寿命方面落后于数十个国家。政府支出通过将资源从富人重新分配给穷人，可能会降低整体死亡率。我们将 2006 年至 2015 年的死亡率数据与美国 149 个最大城市的市和州政府支出联系起来。我们使用加权线性回归，对 2005 年城市和州政府人均支出与死亡率之间的关系进行建模。州政府支出增加 10%（P = 0.008）与美国城市死亡率降低 1.4%（95%CI：0.4-2.4%）相关。市政府支出与死亡率无关（P > 0.10）。然而，在白人中，市政府支出的增加与死亡率降低 4.8%（2.1-7.5%）相关，但在黑人和亚洲人中，市政府支出的增加与死亡率分别增加 1.7%（0.6-2.9%）和 5.1%（2.1-6.2%）相关。州政府支出与美国城市死亡率降低相关。市政府支出似乎有利于白人的长寿，而不利于非白人的长寿。
