美国各州和高收入国家可避免的死亡率
Irene Papanicolas1, Maecey Niksch1, Jose F Figueroa2,3
1Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island.
JAMA internal medicine
|March 24, 2025
概括
美国各州的可避免死亡率上升,而其他高收入国家的死亡率下降,表明存在系统性问题. 与其他国家不同的是,美国的医疗支出与死亡率的减少没有相关性.
科学领域:
- 公共卫生 公共卫生
- 卫生政策 卫生政策
- 医疗保健系统比较研究
背景情况:
- 过去十年来,美国卫生政策和人口健康方面的差异越来越大.
- 对美国各州在可避免的死亡率方面如何在国际上进行比较的理解有限.
研究的目的:
- 为了比较美国各州和欧盟 (欧盟) 和经济合作与发展组织 (经合组织) 的高收入国家之间可避免死亡率的趋势.
主要方法:
- 追溯性,基于人群的,重复的横截面研究.
- 在0-74岁的个体中比较可避免的死亡率 (可预防和可治疗的死亡).
- 分析了2009年至2021年间美国50个州和华盛顿特区以及40个高收入国家的数据.
主要成果:
- 从2009年到2019年,可避免的死亡率在所有美国州都增加,但在大多数比较国家下降.
- 可避免死亡率的变化在美国各州扩大,而在比较国家缩小.
- 在COVID-19期间 (2019-2021年),可避免的死亡率在美国各州和比较国家都增加,基线死亡率较高的地区增加最多.
- 在比较国家观察到卫生支出与可避免死亡率之间存在显著的负相关性,但在美国各州没有.
结论:
- 相反的趋势表明,广泛的系统因素导致美国人口健康状况恶化.
- 其他国家通过增加医疗保健支出来证明健康收益,与美国各州不同,质疑美国卫生支出效率.
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