Just across the northern border of the US, patients with the same devastating genetic condition – cystic fibrosis – are living an average of 10 years longer, researchers reported Monday in the Annals of Internal Medicine.
After adjusting for differences between patients’ overall health, disease severity and clinical factors, a team of US and Canadian researchers found that the median survival age of cystic fibrosis patients is 50.9 years in Canada and 40.6 years in The United States. While the study didn’t fully assess the causes of the “significant survival gap,” the researchers noted that increased access to lung transplants and health care in general seemed to play a role.
In fact, when comparing Canadian patients with universal government-provided health insurance with U.S. patients with private insurance, the researchers found no difference in the risk of death. But U.S. patients with continuous or intermittent Medicare or Medicaid or no insurance at all had a 36 to 77 percent higher risk of death than their Canadian counterparts.
“While we cannot draw definitive causal inferences from these analyses, the observed differences raise the question of whether there is an inequity in access to therapeutic approaches or health care, so that hypotheses can be generated for further research,” the authors conclude.
And further research is indeed warranted, researchers say. “A ten-year difference … that’s many years spent with your child or not, having fun with your friends, living your life,” said University of Windsor epidemiologist Kevin Gorey, who was not involved in the study. STAT. “That’s a huge, huge human tragedy.”
Previous estimates and reviews have pegged the survival rate of cystic fibrosis patients in developing countries from 41.5 to 50 years. But directly comparing survival data between countries is tricky because they may have different methods of tracking and recording patient health data.
To get around this, the authors of the new study tracked detailed health records of 5,941 Canadian patients in 42 cystic fibrosis care centers and 45,448 U.S. patients in 110 care centers from 1990 to 2013. They also divided the patients into subgroups based on the severity of the disease. disease.
Cystic fibrosis is caused by a genetic mutation that breaks an ion channel in tissue-lined cells. The duct is needed to make up for sweat, mucus, and digestive juices. Results of the mutation include thick mucus in the airways that can provide a haven for deadly pathogens, as well as gastrointestinal problems and pancreatic damage. The type of mutation, the type of pathogens that lodge in the lungs, the status of the pancreas, the quality of care and diet can all affect health outcomes.
But taking into account all these factors and dividing patients into subgroups of severity, the researchers still found a large gap between the survival of US and Canadian patients. “The fact that our findings were consistent across subgroups, including those with a severe clinical phenotype, suggests that longer survival in Canada than in the United States is not a result of following patients with milder disease in the Canadian cohort” , the authors conclude.
The results fit into larger trends for the US, which has repeatedly scored low compared to other developed countries when it comes to health care quality. In 2000, the World Health Organization ranked the US health system 37th out of 191 countries, just below Costa Rica. In 2014, the private foundation the Commonwealth Fund ranked the U.S. health system last out of 11 wealthy countries. Currently, Americans’ life expectancy is among the lowest among wealthy countries and is expected to make the fewest gains relative to peers in the coming years. The US also has the highest maternal and infant mortality rates of wealthy nations.
Annals of Internal Medicine2017. DOI: 10.7326/M16-0858 (About DOIs).