Friday, December 17, 2010

Income and Life Expectancy. What does it Tell Us About US?

Statistician Hans Rosling, in a BBC documentary called The Joy of Stats, presents a neat 3-D graph presented below about how life expectancy in wealthy countries has improved over the last 200 years from the time of Napoleon Bonaparte to the present while poorer countries continue to lag behind. You can see in the clip below how the countries in the world look like a swarm of ants crawling towards a puddle of sugar water.

Rosling points out interesting sub-trends in different countries such as China, the fastest growing economy on earth, where it's richer provinces such as Shanghai resemble Europe in life expectancy now while it's poorer ones still resemble the third world. He mentions the richest country on earth in gross domestic product, the United States of America which was number one in the world right after World War II per capita (adjusted for population, the USA now ranks 9th in the world in per capita GDP. Luxembourg is first).

The United States with it's wealth is currently tied with Cuba (ranked 87th in per capita gross domestic product according to the CIA factbook) at 36th in the world in life expectancy according to the United Nations (Japan is first). In a previous post I discussed a study where there were an estimated 45,000 excess annual deaths in the US due to a lack of health insurance even after adjusting for other risk factors such as smoking and poverty. Can this be the only reason for the US's poor showing in life expectancy?

One of the risk factors that was adjusted for in the study on the uninsured is poverty which has been on the rise in this country, even before the economic collapse of 2008, and is correlated with the number of uninsured here. The poor are more likely to fight in our wars now that our armed forces are all volunteer and they are wooed with incentives like free health care and the GI bill.

Breaking down the life expectancy by state in 2005 it is the poorer ones such as Mississippi which tend to have lower life expectancies with one outlier, the District of Columbia with a highest per capita income at $61,092 but the lowest life expectancy at 73.8 years of any state in 2007 according to the Census Bureau. Doing a statistical test of this relationship, there is a positive correlation between income and life expectancy that is borderline significant that only accounts for 8% of the variance.
When the data is reanalyzed with the District of Columbia excluded because technically it is a city and not a state and it is an outlier, the relationship looks a lot stronger with a more highly significant correlation accounting for 31% of the variance.

The question remains why was DC such an extreme outlier in this data. There are obviously areas of high income but also areas of extreme poverty in DC with high crime rates. Also many wealthier residents may be better able to move out of the district to the Virginia suburban counties which have the highest income levels in the US.

The gap between rich and poor here in the US has gotten wider in the last 30 years. President Obama's compromise with Senate Republicans on extending the Bush tax cuts on everyone including the rich has been passed. Raising the income tax rates on the highest earners from 36% to 39% would have been a timid increase but would have helped (it's a lot higher in other countries). Republicans would have held up all legislation to get this passed. They did hold up a health care bill for 9/11 (which would have been unnecessary if the US had comprehensive universal health coverage) first responders who were exposed to hazardous materials. Jon Stewart gave a good review of it's impact on real people and how the media covers it.


After considerable prodding, the US Senate did finally pass the 9/11 responder bill but many health care and income disparities remain in DC and the rest of the US. Marian Wright Edelman has a good review of what these statistics mean for people and children in the US' poorest state and next to lowest in life expectancy, Mississippi. This article is about children receiving assistance from a foundation in the Netherlands. Some more food for thought as the holidays near.

Foreign Aid for Mississippi's Children

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Teapartiers sandbagged by health insurers | MollyRush's Blog and a calculation mortality rates for lack of insurance.

Wednesday, December 15, 2010

Teapartiers sandbagged by health insurers | MollyRush's Blog and a calculation mortality rates for lack of insurance.

Molly Rush, Pittsburgh health insurance activist and blogger, brilliantly in her blog about how the health insurance companies were giving money to anti healthcare groups such as the US Chamber of Commerce (covertly due to the Citizens United decision by the US Supreme Court) while at the same time negotiating with the Obama administration for the most advantageous deal possible with an individual mandate requiring everyone to buy their product.

Teapartiers sandbagged by health insurers | MollyRush's Blog

Stephen Colbert gives a good review of how the debate went in the past year.

The Colbert ReportMon - Thurs 11:30pm / 10:30c
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A Federal judge in Virginia has ruled that the individual mandate is unconstitutional meaning that the US Supreme Court will have to resolve this issue. This ruling may be good news not just for those who want to kill the bill but for those who want to improve it with a public option and single payer alternatives.

In 2009 an analysis by Andrew P. Wilper MD MPH, Steffie Woolhandler, MD, MPH, Karen E. Lasser, MD, MPH, Danny McCormick, MD, MPH, David H. Bor, MD,
and David U. Himmelstein, MD at Harvard estimated that about 45,000 people die due to a lack of health insurance per year. This estimate was cited by Alan Grayson on the US House floor and raised the ire of the right who refused to believe this estimate. I cited this estimate at the height of the debate on my facebook page and many of my conservative friends also refused to believe. I feel the need to recount how they arrived at that estimate now. The whole article can be read at this link.

Health Insurance and Mortality in US Adults

Wilper et al. began with the Third National Health and Nutrition Examination Survey (NHANES III) to estimate mortality rates in those aged between 17 and 64. It is a representative sample (using similar methodology that was used in the exit polling for the 2010 election) of the US population where a vast array of health data was collected on on habits, weight, blood pressure, demographics such as race and poverty, etc. This data was linked to data from the National Death Index to tell the researchers if they were alive or dead at the time of the analysis. Before the data was given to the researchers any information that could identify the participants was scrubbed from the file. The data were analyzed using Cox regression survival analysis and they found that after adjusting for all other potential risk factors for mortality there was an estimated 40% elevated risk of death for those uninsured relative to those insured. Applying this 40% elevated risk to census data for the US population and the size of the uninsured population which is bigger now (50 million) than it was when this article was published (46 million) gives the 45,000 excess deaths estimate which many kill the billers dispute.

Many may still disregard these estimates just as they have in the related post on health care polling below. Anyone who doubt that there is still a crisis of access to health care in the United States should come to a free clinic and talk to those receiving care. Many of whom have not received care in years.

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