"Life Expectancy" Doesn't Measure How Long You're Expected To Live(blog.edwardmarks.com) |
"Life Expectancy" Doesn't Measure How Long You're Expected To Live(blog.edwardmarks.com) |
Life expectancy is not entirely medical and is not a particularly good way to compare countries. Consider that among the top causes of death in the US are "accidents" (predominantly motor vehicles) and suicide, both of which are anomalously high in the US.
Consider also that if you go to the top US cause of death (heart disease, clearly medical) and then compare the world rankings for heart disease deaths, you'll find many of the countries that beat the US in the life expectancy rankings do worse than the US in the heart disease mortality rankings.
You'll tend to see similar effects for other medical issues, particularly cancer, in which the US notoriously outperforms many of the European countries that outrank it on life expectancy.
If by not entirely medical you mean overwhelmingly not medical, then yes. Of the 30 years that life expectancy increased in the 20th century, 25 of those years were do to non-medical factors according to the CDC.
Furthermore, if you actually look at the top 'medical' causes of death, they can overwhelmingly be prevented by non-medical means. To quote from Overdose In America, "Simply eating fish once a week reduces the risk of stroke by 22 percent. Controlling high blood pressure reduces the risk of stroke by 35 to 45 percent. And even moderate exercise for less than two hours a week reduces the risk of stroke in an elderly population by about 60 percent."
Furthermore, just 1.2% of Americans meet all 7 cardiovascular health metrics from 2005 to 2010, compared to 2% from 1988 to 1994. These metrics are not smoking, being physically active, having blood pressure under control, maintaining healthy blood glucose levels, maintaining healthy blood cholesterol levels, mainting a healthy body weight, and following a healthy and balanced diet.
Usually the way I hear this statistical point made is that the US leads the world in life expectancy when accidental injuries and violent crime are omitted. (Usually the point is deployed to caution people against making quick conclusions about US diet or medical care quality from national life expectancies, as for example here: http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-amer...)
But this has a disproportionate effect on low life expectancy, because early death has a disproportionate effect on life expectancy stats. 1 person dying at age 20 (instead of 80) has the same effect on life expectancy as 60 people dying at age 79 (instead of 80).
Probably some part of the vehicle deaths will "leak" over to other categories, but there should be an overall reduction.
FWIW, I looked into this using the tables on http://www.worldlifeexpectancy.com/cause-of-death/all-cancer... - not just the all cancers table, but also the separate tables for different types of cancer. The implication of what you write - that the US has better medical healthcare - didn't seem to stand out. Rather, it looked like different European countries have markedly different death rates from different cancers. Things like diet, lifestyle, prevalence of smoking, etc. seem like a better explanation for the variance. France has especially low heart disease deaths, for example, but slightly higher cancer deaths than the US. Etc.
And of course we all die of something, so I would expect cancer deaths to be higher in a country with a higher life expectancy even if the medical success in treatment was higher. Third world countries generally do not have high deaths from cancer.
The United States ranks #41, ahead of much of the EU but behind Germany and France, on ovarian cancer.
The United States ranks #61, again ahead of almost all of the EU, on breast cancer.
Here I might point out that to come in much higher than the US in these numbers, ie, to be Gabon, you have to have a lot of people dying before they can get cancer. Moving on:
The United States ranks #27 on leukemia, besting France, Poland, the Czech Republic, and Hungary.
The United States is #170 on stomach cancer, ahead of all of Europe.
The United States does worse than Europe on lung cancer, and is right in the middle of the pack on skin cancer. Other than that, the narrative is pretty clear.
If I have a higher-than-average chance of dying in an automobile accident in a specific country, that's good information to have. In fact, I want to know all the particularly common ways I could die somewhere, be it via car or mortar attack. I think that's a great way to compare countries and life expectancy. Maybe I miss your point?
Though if what you meant was that motor vehicle accidents were not a good reflection of the quality of our medical care, I expect that would be a fair assessment.
But yes, I was making the latter point.
Does life expectancy tell us something about the differences between life in the United States and Finland? Yes... but what if all it's telling us is "the United States is simultaneously less dense and comparably urban to Europe"?
Road quality in the United states is low compared to other OPEC countries
Seatbelts and motorbike helmets are still not mandatory in all US states
Car quality and safety in the United States is lower than other OPEC countries
EDIT: I meant OECD, not OPEC.
Depends. Does getting shot while driving count? ;-)
Maybe I am getting it wrong but does it matter how you die? Generally speaking (averaged out,) if you live in US and do what the average person does, you will get in accidents and deal with the pressures that push some to suicides (around 10 to 22 per 100,000 http://www.bloomberg.com/news/2011-04-14/suicide-rates-rise-... .) Even if you are careful, the recently licensed teenager, to stereotype, can ram his car into yours.
* How many more years do you expect to live if you are already X years old in 2012?
This is obviously different than just calculating from the cohort life expectancy of 2012-X since you you've already passed the vulnerable infancy stage. Also, say you are 90 today, so your cohort exp, for 1922 births must be something like, say 80. Your expectation of living more is certainly not -10 years!
This is of course false. Back in the early 1900's when life expectancy was only around 60, if you survived your childhood, you'd likely live to 70 or 80.
This didn't seem right so I checked. A 20 year old in 1900 could expect to live to 62. In 1939 (4 years after SS was first put in place) a 20 year old would live to 67.
Interpretted as a median age of death, you are right that more than 50% of 20 year-olds collected at least 1 check, but a significant fraction died before retirement age, and they generally didn't say in retirement for decades.
http://www.infoplease.com/ipa/A0005140.html I used white males, and women lived longer but non-whites lived shorter.
By the time you hit 60, you've gone from ~75 to ~80.
I'd like to see a plot of the distribution of lifetime as a function of birth year. I.e. a 3D plot with current age on the X axis, age of death on the Z axis, and probability on the Y axis. (Where, as in Minecraft, X is east/west, Z is south/north.)
Cut off the portion representing people who have died already (Z < now-X), renormalize each cohort so its Y values add up to 1, and you'll get the distribution of lifetimes for people who are alive today. (I.e. a conditional distribution, conditioned on being alive today.) Which at least one other poster was asking about.
"Biodemography of human ageing" Nature. 2010 Mar 25;464(7288):536-42. doi:10.1038/nature08984
http://www.demographic-challenge.com/files/downloads/2eb51e2...
covers most of the essential issues. His striking finding is "Humans are living longer than ever before. In fact, newborn children in high-income countries can expect to live to more than 100 years. Starting in the mid-1800s, human longevity has increased dramatically and life expectancy is increasing by an average of six hours a day."
http://www.prb.org/Journalists/Webcasts/2010/humanlongevity....
Meanwhile, a person at any given age can look up period life tables for what the blog post author of the post submitted here correctly describes as a MINIMUM life expectancy at that person's current age.
http://www.ssa.gov/oact/STATS/table4c6.html
http://www.infoplease.com/ipa/A0005140.html
(The links shown are for United States data, but data like these are available for most developed countries.)
It is also possible to find life expectancy formulas adjusted for personal health status and lifestyle.
http://www.msrs.state.mn.us/info/Age_Cal.htmls
(Minnesota data)
http://www.bupa.com.au/health-and-wellness/tools-and-apps/to...
(Australia data)
The link posted last week
http://www.scientificamerican.com/article.cfm?id=longevity-w...
gives good data on trends in causes of death from 1960 to the present in the United States and in OECD countries as a whole. It showed that life expectancy at birth, at age 40, at age 60, at age 65, and at age 80 have all increased during the years shown on the chart.
One comment regarding the yearly progress of the cohort rate. I would think this would fluctuate with significant medical advances (e.g. the first few years that bypass surgery/artificial hearts started to be used). I can't see how medical progression is perfectly linear at 1.0%/year.
In the UK (population 70 million), 28,000 heart bypass operations happen per year. The number of people who will have one is in the low single digits as a percentage of the population.
Even for those people who do have one there is no guarantee that it will have a significant impact on their lives. Yes for some it will but for others it's only reduced one possible cause of death and a lot of the behaviours that lead to heart problems also lead to, say cancer, or diabetes, or liver failure, or something else that will cut your life short.
Then compare that to the thousands of small improvements.
I can see it might not be constant over an extended period, but I don't think there are many, if any, things that would cause a significant spike.
While it's hard to predict, I personally wouldn't bet against a game changing spike in the coming decades. It's only very recently that medicine has started riding Moore's law. Robotics and miniaturization are speeding up basic research by orders of magnitude.
I don't think it's unreasonable to say that biology has achieved more in the past two decades than in all preceding history. And there's no sign that the exponential is running out.
Granted, there may be fundamental limits that we don't appreciate yet. That's the whole draw of science, we simply don't know.
This makes sense - medical advances won't be widely adopted immediately, then there will be a gradual acceleration of adoption (and improvement rate) once its benefits are proven and costs come down, and then no further contribution to improvements once wide adoption is the norm.
What you also tend to see is that advances affect improvements by year of birth more prominently than by year of discovery. In the UK we have a 'golden cohort' for example, which you could Google for more info.
Spikes do tend to occur during and after big causes of death (spanish flu, world wars) as the improvement rate drops sharply and then recovers again.
They keep dangling that retirement carrot in front of us, but by the time we get to enjoy it, we're dead.
[1]en.wikipedia.org/wiki/Boxer_(Animal_Farm)
I guess my point also has to do with what "averages" mean. In 1939, a 20 year old might _on average_ live to 67, but that means a number would die at 47, but a similar amount would live to 87.
You may be right but there will still be bottlenecks in the process around patient trials and the more "manual" stages of any treatment.
I think the next big improvement will likely not register on life expectancy because it will be in response to a specific problem. The next generation of anti-biotics for instance will have a massive impact but will likely only cancel out the negative impact of drug-resistant strains of bacteria.
Looking at things like http://en.wikipedia.org/wiki/Crime_in_the_United_States, it implies that the US murder rate would have doubled, rather than halved.
I'd suggest it is worth a separate post.
But the US is definitely in the lead on breast cancer. No doubt about that.
Now compare that result to life expectancy rankings. That's the point I'm making.
Given the shit the world generally dumps on women, I'd say the female gender is simply built of sterner emotional stuff than their male counterparts.
that bias-based unequal pay for women is largely a myth, and that women are most often paid less than men not because they are discriminated against, but because they have made lifestyle choices that affect their ability to earn.
http://www.amazon.com/Why-Men-Earn-More-Startling/dp/0814472...
This makes sense. I suppose women ask for help more, and sooner than men (and probably get it too). Does anyone know, what is the percentage of men vs women, who actually go to psychiatrists? That might give some idea
that they actually get sympathy for, instead of being told to 'suck it up' and 'be a man' when they attempt to find help.
Point being: something's going on here that confounds life expectancy comparisons.
PS: It's hard to get good data. Japan has twice the US suicide rate and a longer life expectancy. However, some of their numbers are off due to people not reporting deaths so they can continue to collect pension benefits.
If you're wealthy, the US health care system is so good that not only does it outdo Europe's system at handling heart disease and cancer, but it does so much better than Europe's that the effect is evident from mortality statistics even though 75MM people in the US make less than $22,000/yr. At the same time, you're saying that regardless of the fact that US hospitals are required by law to treat indigent patients regardless of cost, enough people receive so little care that they bias the mortality statistics.
This seems like an extraordinary claim.
I am not an apologist for the US health care system, as a cursory look at HNSearch will show you. But I don't think the problem is that people don't get care in the US; it is, as policy wonks will tell you, better (from a health care perspective) to be homeless in 2012 than it was to be President in 1955. The problem is that the US health care system routinely bankrupts patients.
I don't know about overall accidents, and I don't have numbers memorized, but I know that vehicle accident deaths have dropped pretty significantly over the last couple of decades. Trends are relevant, too.
Colorado's front range, for example, would almost certainly benefit from having a well-developed commuter rail system, with heavy passenger rail connecting the corridor from Colorado Springs to Fort Collins (with a spur to Boulder) and light rail taking people from the terminals to points spread further out.
Doing something like this would take a long time and cost a lot of money, but our choice (so far) not to spend that money in most metro areas has a direct effect on the quality of life in this country.
The Front Range is indeed making a large investment in commuter rail, though not yet all the way to Colorado Springs & Fort Collins: http://www.rtd-fastracks.com/systemmap.php
The Los Angeles area is likewise making significant investments in its rail system.
And yeah; you can have public transit in the 'burbs? but it's not going to be popular. Because you have so much more living space than a city dweller, you are likely to get more utility out of the hauling capacity of a car. And having that extra living space also dramatically lowers the cost of owning the car; You don't have to pay for parking, and you can do basic work in the garage. (you can save a giant wad of cash doing basic stuff like swapping rotors yourself.)
Personally, I think the economic realities of the suburbs mean that only the poorest of the poor are going to not own personal vehicles; because of this, public transit is built for and associated with the poor in all but the most built-up parts of America. "Domestic help" is not fashionable here, either, so for the middle class, there isn't a lot of upside to letting poor people into their neighbourhoods. (I'm wondering if this is going to change with the rise of in-home elder-care. There certainly are plenty of Americans willing to do that sort of work for wages the middle-class could pay.)
OECD
In other words, you think car quality in the US is lower than that of countries like Tajikistan, Swaziland, Kazakhstan, and Ecuador. When you say "OECD", you might as well say "the entire world". I officially doubt your statistics.
I also think the road and car quality questions are up for debate.
Obviously road and car quality are up for debate, but once you spend some time driving around Europe in European cars, you'll see what I mean.
Whenever a stat says something interesting that could be improved about America, it seems Americans find a way of dismissing the data as "not really appropriate for reasons x,y,z", thus leaving the original problem unimproved.
If you're just trying to make a case that we should mandate rear passenger seatbelts, I'm not arguing with you. I'm talking about life expectancy stats.
This is unclear as well. This stylized "fact" only became a talking point in the last election, and is drawn almost exclusively from a deeply flawed study by Elizabeth Warren.
http://www.theatlantic.com/business/archive/2009/06/elizabet...
http://www.theatlantic.com/business/archive/2010/12/will-hea...
Among other flaws, the study doesn't measure causation or even correlation.
http://echealthinsurance.com/health-insurance-advisor/wp-con...
The fun stuff starts on age 18.
A huge number of Americans have conditions with a "D" in the right-hand column, which is "automatic decline coverage". Many of those people cannot get insurance on the private market at any cost.
Why do you have a hard time believing that our health care system needlessly bankrupts people?
Is it something along the lines of, "there is a savvy way to negotiate this system without having health insurance"? I'm prepared to concede that someone knows someone who's mom paid pennies on the dollar for care by playing hardball with providers. I just don't think that's a viable solution to the problem overall; providers will more often than not just send the bills to collections.
If I may submit two personal stories in place of rigorous data:
my incredibly poor sister recently injured herself and was facing nominal charges of about $40,000. She was able to get that written down to a few grand and then get donations from family, friends, and charities to cover her bills. She didn't have to "play hardball"; she just explained her situation and the hospital bent over backwards to help her. The hospital staff treated it as a routine occurrence.
My wife and I do not have health insurance at all. We use something called "Christian Healthcare Ministries" [0] which is not insurance, and (at our level of participation) doesn't cover routine visits or small problems, but covers us in case of conditions that might otherwise bankrupt us. So while I personally cannot get insurance on the open market, and routinely get counted in the "not insured" category, I still have coverage.
(Note that I'm not defending the US health care system overall, just introducing some information about alternatives that help people avoid bankruptcy.)
I'd like to see good evidence that it's a significant problem. You haven't provided any. No one I've asked has provided any, beyond Elizabeth Warren's study and the claim that it's "obvious".
As for "savvy way", it's paying in cash, up front. Prices magically drop when payment is convenient. In my experience, and those of the many uninsured people I know, it's that simple. I'm going to speculate that you don't know very many uninsured people...
(Sadly, there is little data on this. If you have some, I'd love to see it.)
However, for a simple idea of how bad the US healthcare system really is look at this: http://www.cddep.org/tools/methicillin_resistant_staphylococ...
I'd observe that in general, the complaint with the US medical system is that it is too expensive, or that for what we pour into it it ought to be clearly the best everywhere across all measures instead of merely near the top. (Which is rather more accurate; it isn't "slightly below average", it's "slightly behind best", and there are rather a lot of individual measures in which it is the best.) It isn't that it's a terrible system in general. You have to game stats pretty hard to make it an actively bad system in terms of raw outcome.
This is probably not the case, but since this is hacker news I'm being a dork about the math.
I obviously do not have the specific stats at my fingertips to refute the anecdote you've supplied, but if there were a way for us to bet on which of our arguments the correct statistic is going to support, I'd bet on my argument.
Still, for those numbers to be useful the rate of infection, detection, treatment, death, AND linking deaths to MRSA must be considered before you can compare those healthcare systems as well as a near constant rare of infection.
PS: I have awesome medical coverage, that limits out of pocket expenses to 2k per year with an unlimited sealing. However, many plans cap lifetime expenditures to 1million in coverage because people really do spend that much and far more.
But without "automatic decline" conditions, which were critical to tptacek's point.
> "nominal charges of 40k is small potatoes"
Sure. But the cover story of CHM's latest newsletter [0] is a woman with a $300k bill that was reduced to $20k. Elsewhere in the newsletter is a request for donations to cover about $60k of a bill that has had $200k of reductions. There are, occasionally, bills that break the $1 million mark, though they usually come with reductions in the $500k+ range. Point being, very substantial reductions and charitable donations are common.
Again, I'm not specifically defending the status quo. I'm just saying, there are definitely options that allow some people with pre-existing conditions or catastrophic illness to avoid bankruptcy.
[0] https://www.chministries.org/downloads/newsletters/CHMSeptem...
I'm not sure what the second sentence means. If you're saying we don't know how to properly attribute deaths to MRSA, what does any MRSA statistic say about health care?
You have a long row to hoe with the overall argument you're making. It is, for instance, not hard to link deaths to heart disease, and heart disease is the leading cause of death in the US. The US has fewer heart disease deaths per 100,000 people than Austria, Sweden, Norway, Iceland, the UK, Finland, the Czech Republic, Ireland, Hungary, and Slovakia, and is closer to Germany and Denmark, the #14 and #15 followers to the US's #12, than it is to Austria's #11.
PS: Perhaps the most humorous being http://en.wikipedia.org/wiki/Fan_death, but the sadist and most blunt is probably: http://en.wikipedia.org/wiki/Sudden_infant_death_syndrome which is literally 'death without obvious cause'.