The US Health Care System and Lagging Life Expectancy: A Case Study

Life expectancy in the United States fares poorly in international comparisons. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral factors. This paper compares mortality trends from prostate cancer in the United States to those in other developed countries. Prostate cancer is chosen because it can be detected at an early stage, because effective treatments are available, and because it is less heavily influenced by behavioral factors than most other chronic diseases. We find that, after the introduction of the PSA screening test for prostate cancer, mortality from the disease declined significantly faster in the United States than in the set of comparison countries. Trends in incidence and survival rates support the interpretation that the US health care system has worked very effectively to reduce mortality from this important disease. A brief consideration of breast cancer suggests that similar processes may have been at work among women

Low Life Expectancy in the United States: Is the Health Care System at Fault?

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system

US Mortality in an International Context: Age Variations

Retirement Research Consortium. The findings and conclusions expressed are solel

Interactional formats and institutional context: a practical and exploitable distinction in interviews

This paper applies practically oriented discourse analysis to focus group interviews using conversation analytic principles to show how interactional qualities demonstrably different to analysts are also treated as such by participants. We take a grounded practical theory perspective to claim that the empirical and practical distinction is an exploitable resource for participants, with important implications for the goals of research interviewing, interviewee participation in focus groups, and analyses thereof. We identify participant techniques for doing and attending to conversational and institutional interaction formats, including turn-taking organization, embodied acts, addressivity, and emotion displays, and how those techniques allow participants to co-construct emergent stances alongside answering questions

Low Life Expectancy in the United States: Is the Health Care System at Fault?

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.

What Demographers Need—and What the World Needs from Demographers—in Response to Covid-19

This essay discusses the need to ensure the integrity and timeliness of data releases and to employ a population perspective in understanding the impacts of the Covid-19 pandemic

Contribution of smoking-attributable mortality to life expectancy differences by marital status among Finnish men and women, 1971-2010

BACKGROUND Smoking is known to vary by marital status, but little is known about its contribution to marital status differences in longevity. We examined the changing contribution of smoking to mortality differences between married and never married, divorced or widowed Finnish men and women aged 50 years and above in 1971-2010. DATA AND METHODS The data sets cover all persons permanently living in Finland in the census years 1970, 1975 through 2000 and 2005 with a five-year mortality follow-up. Smoking-attributable mortality was estimated using an indirect method that uses lung cancer mortality as an indicator for the impact of smoking on mortality from all other causes. RESULTS Life expectancy differences between the married and the other marital status groups increased rapidly over the 40-year study period because of the particularly rapid decline in mortality among married individuals. In 1971-1975 37-48% of life expectancy differences between married and divorced or widowed men were attributable to smoking, and this contribution declined to 11-18% by 2006-2010. Among women, in 1971-1975 up to 16% of life expectancy differences by marital status were due to smoking, and the contribution of smoking increased over time to 10-29% in 2006-2010. CONCLUSIONS In recent decades smoking has left large but decreasing imprints on marital status differences in longevity between married and previously married men, and small but increasing imprints on these differences among women. Over time the contribution of other factors, such as increasing material disadvantage or alcohol use, may have increased.Peer reviewe

A case study of the Neti Pot’s rise, americanization, and rupture as integrative medicine in U.S. media discourse

In a period of only one decade in the United States, the neti pot shifted from obscure Ayurvedic health device to mainstream complementary and integrative medicine (CIM), touted by celebrities and sold widely in drug stores. We examine the neti pot as a case study for understanding how a foreign health practice became mainstreamed, and what that process reveals about more general discourses of health in the United States. Using discourse analysis of U.S. popular press and new media news (1999–2012) about the neti pot, we trace the development of discourses from neti’s first introduction in mainstream news, through the hype following Dr. Oz’s presentation on Oprah, to 2011 when two adults tragically died after using Naegleria fowleri amoeba-infested tap water in their neti pots. Neti pot discourses are an important site for communicative analysis because of the pot’s complexity as an intercultural artifact: Neti pots and their use are enfolded into the biomedical practice of nasal irrigation and simultaneously Orientalized as exotic/magical and suspect/dangerous. This dual positioning as normal and exotic creates inequitable access for using the neti pot as a resource for increasing cultural health capital (CHC). This article contributes to work that critically theorizes the transnationalism of CIM, as the neti pot became successfully Americanized. These results have implications for understanding global health practices’ incorporation or co-optation in new contexts, and the important role that popularly mediated health communication can play in framing what health care products and practices mean for consumers

Rapid detection of BRCA1/2 recurrent mutations in Chinese breast and ovarian cancer patients with multiplex SNaPshot genotyping panels.

BRCA1/2 mutations are significant risk factors for hereditary breast and ovarian cancer (HBOC), its mutation frequency in HBOC of Chinese ethnicity is around 9%, in which nearly half are recurrent mutations. In Hong Kong and China, genetic testing and counseling are not as common as in the West. To reduce the barrier of testing, a multiplex SNaPshot genotyping panel that targeted 25 Chinese BRCA1/2 mutation hotspots was developed, and its feasibility was evaluated in a local cohort of 441 breast and 155 ovarian cancer patients. For those who tested negative, they were then subjected to full-gene testing with next-generation sequencing (NGS). BRCA mutation prevalence in this cohort was 8.05% and the yield of the recurrent panel was 3.52%, identifying over 40% of the mutation carriers. Moreover, from 79 Chinese breast cancer cases recruited overseas, 2 recurrent mutations and one novel BRCA2 mutation were detected by the panel and NGS respectively. The developed genotyping panel showed to be an easy-to-perform and more affordable testing tool that can provide important contributions to improve the healthcare of Chinese women with cancer as well as family members that harbor high risk mutations for HBOC

Disentangling the Black Hole Mass Spectrum with Photometric Microlensing Surveys

From the formation mechanisms of stars and compact objects to nuclear physics, modern astronomy frequently leverages surveys to understand populations of objects to answer fundamental questions. The population of dark and isolated compact objects in the Galaxy contains critical information related to many of these topics, but is only practically accessible via gravitational microlensing. However, photometric microlensing observables are degenerate for different types of lenses, and one can seldom classify an event as involving either a compact object or stellar lens on its own. To address this difficulty, we apply a Bayesian framework that treats lens type probabilistically and jointly with a lens population model. This method allows lens population characteristics to be inferred despite intrinsic uncertainty in the lens-class of any single event. We investigate this method's effectiveness on a simulated ground-based photometric survey in the context of characterizing a hypothetical population of primordial black holes (PBHs) with an average mass of $30 M_{\odot}$. On simulated data, our method outperforms current black hole (BH) lens identification pipelines and characterizes different subpopulations of lenses while jointly constraining the PBH contribution to dark matter to ${\approx}25$\%. Key to robust inference, our method can marginalize over population model uncertainty. We find the lower mass cutoff for stellar origin BHs, a key observable in understanding the BH mass gap, particularly difficult to infer in our simulations. This work lays the foundation for cutting-edge PBH abundance constraints to be extracted from current photometric microlensing surveys.Comment: 31 pages, 18 figures, submitted to AA