While health outcomes of White Americans living in the richest counties are better than those of average U.S. citizens, the outcomes are not consistently better than those of average residents in many other developed countries, according to findings from a comparative effectiveness study published Dec. 28 in JAMA Internal Medicine. "Even if everyone achieved the health outcomes of White U.S. citizens living in the 1% and 5% richest counties, health indicators [in the U.S.] would still lag behind those in many other countries," the study authors said.

Ezekiel J. Emanuel, MD, PhD, Emily Gudbranson, BA, et al., analyzed data from White citizens living in the 1% (n=32) and 5% (n=157) highest-income counties in the U.S. between Jan. 1, 2014 and Dec. 31, 2015 and measured health outcomes related to infant and maternal mortality, colon and breast cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction (AMI). This data was then compared with outcomes among average U.S. residents and all residents in 12 other developed countries, including Australia, Austria, Canada, Denmark, Finland, France, Germany, Japan, the Netherlands, Norway, Sweden and Switzerland.

Overall findings showed White U.S. citizens in the 1% and 5% highest-income counties obtained better health outcomes than average U.S. citizens but had worse outcomes for infant and maternal mortality, colon cancer, childhood acute lymphocytic leukemia, and AMI compared with average citizens of other developed countries. The authors did note that the 5-year survival rate for breast cancer among White U.S. women in the highest-income counties was 92.0%, higher than in all 12 comparison countries – likely due to the push for mammogram screenings in the U.S.  

According to the authors, their findings underscore that being well-off and White in the U.S. is associated with better health outcomes than those experienced by average U.S. citizens, yet at the same time being well-off and White does not guarantee the world's best health outcomes. They also point out that "even if the dramatic and pervasive inequalities in the provision of U.S. health care across race/ethnicity and socioeconomic status were resolved so that every U.S. citizen experienced health outcomes consistent with those of privileged U.S. citizens, the U.S. would still not rank among the best of comparison countries." They write that these findings "suggest – but do not prove – that health outcomes depend on the system of care, rather than the performance of individual physicians or hospitals."

Keywords: Breast Neoplasms, Survival Rate, Ethnic Groups, Maternal Mortality, Sweden, Netherlands, Switzerland, Austria, Japan, Finland, Developed Countries, Early Detection of Cancer, Mammography, Socioeconomic Factors, Income, Social Class, Colonic Neoplasms, Hospitals, Delivery of Health Care, Physicians, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Myocardial Infarction, Outcome Assessment, Health Care, Denmark, ACC International

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