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People with cystic fibrosis (CF) survive an average of 10 years longer if they live in Canada than if they live in the United States, according to a report published online March 14 in Annals of Internal Medicine.
Differences between the two nations’ health care systems, including access to insurance, “may, in part, explain the Canadian survival advantage,” said Anne L. Stephenson, MD, PhD, of St. Michael’s Hospital, Toronto, and her associates.
Overall there were 9,654 U.S. deaths and 1,288 Canadian deaths during the study period, for nearly identical overall mortality between the two countries (21.2% and 21.7%, respectively). However, the median survival was 10 years longer in Canada (50.9 years) than in the United States (40.6 years), a gap that persisted across numerous analyses that adjusted for patient characteristics and clinical factors, including CF severity.
One particular difference between the two study populations was found to be key: Canada has single-payer universal health insurance, while the United States does not. When U.S. patients were categorized according to their insurance status, Canadians had a 44% lower risk of death than did U.S. patients receiving continuous Medicaid or Medicare (95% confidence interval, 0.45-0.71; P less than .001), a 36% lower risk than for U.S. patients receiving intermittent Medicaid or Medicare (95% CI, 0.51-0.80; P = .002), and a 77% lower risk of death than U.S. patients with no or unknown health insurance (95% CI, 0.14-0.37; P less than .001), the investigators said (Ann. Intern. Med. 2017 Mar 14. doi: 10.7326/M16-0858). In contrast, there was no survival advantage for Canadian patients when compared with U.S. patients who had private health insurance. This “[raises] the question of whether a disparity exists in access to therapeutic approaches or health care delivery,” the researchers noted.
This study was supported by the U.S. Cystic Fibrosis Foundation, Cystic Fibrosis Canada, the National Institutes of Health, and the U.S. Food and Drug Administration. Dr. Stephenson reported grants from the Cystic Fibrosis Foundation and fees from Cystic Fibrosis Canada. Several of the study’s other authors reported receiving fees from various sources and one of those authors reported serving on the boards of pharmaceutical companies.
Stephenson et al. confirmed that there is a “marked” [survival] “advantage” for CF patients in Canada, compared with those in the United States.
A key finding of this study was the survival difference between the two countries disappeared when U.S. patients insured by Medicaid or Medicare and those with no health insurance were excluded from the analysis. The fundamental differences between the two nations’ health care systems seem to be driving this disparity in survival.
Median predicted survival for all Canadians is higher than that of U.S. citizens, and this difference has increased over the last 2 decades.
Patrick A. Flume, MD, is at the Medical University of South Carolina in Charleston. Donald R. VanDevanter, PhD, is at Case Western Reserve University in Cleveland. They both reported ties to the Cystic Fibrosis Foundation. Dr. Flume and Dr. VanDevanter made these remarks in an editorial accompanying Dr. Stephenson’s report (Ann. Intern. Med. 2017 Mar 14. doi: 10.7326/M17-0564).
Stephenson et al. confirmed that there is a “marked” [survival] “advantage” for CF patients in Canada, compared with those in the United States.
A key finding of this study was the survival difference between the two countries disappeared when U.S. patients insured by Medicaid or Medicare and those with no health insurance were excluded from the analysis. The fundamental differences between the two nations’ health care systems seem to be driving this disparity in survival.
Median predicted survival for all Canadians is higher than that of U.S. citizens, and this difference has increased over the last 2 decades.
Patrick A. Flume, MD, is at the Medical University of South Carolina in Charleston. Donald R. VanDevanter, PhD, is at Case Western Reserve University in Cleveland. They both reported ties to the Cystic Fibrosis Foundation. Dr. Flume and Dr. VanDevanter made these remarks in an editorial accompanying Dr. Stephenson’s report (Ann. Intern. Med. 2017 Mar 14. doi: 10.7326/M17-0564).
Stephenson et al. confirmed that there is a “marked” [survival] “advantage” for CF patients in Canada, compared with those in the United States.
A key finding of this study was the survival difference between the two countries disappeared when U.S. patients insured by Medicaid or Medicare and those with no health insurance were excluded from the analysis. The fundamental differences between the two nations’ health care systems seem to be driving this disparity in survival.
Median predicted survival for all Canadians is higher than that of U.S. citizens, and this difference has increased over the last 2 decades.
Patrick A. Flume, MD, is at the Medical University of South Carolina in Charleston. Donald R. VanDevanter, PhD, is at Case Western Reserve University in Cleveland. They both reported ties to the Cystic Fibrosis Foundation. Dr. Flume and Dr. VanDevanter made these remarks in an editorial accompanying Dr. Stephenson’s report (Ann. Intern. Med. 2017 Mar 14. doi: 10.7326/M17-0564).
People with cystic fibrosis (CF) survive an average of 10 years longer if they live in Canada than if they live in the United States, according to a report published online March 14 in Annals of Internal Medicine.
Differences between the two nations’ health care systems, including access to insurance, “may, in part, explain the Canadian survival advantage,” said Anne L. Stephenson, MD, PhD, of St. Michael’s Hospital, Toronto, and her associates.
Overall there were 9,654 U.S. deaths and 1,288 Canadian deaths during the study period, for nearly identical overall mortality between the two countries (21.2% and 21.7%, respectively). However, the median survival was 10 years longer in Canada (50.9 years) than in the United States (40.6 years), a gap that persisted across numerous analyses that adjusted for patient characteristics and clinical factors, including CF severity.
One particular difference between the two study populations was found to be key: Canada has single-payer universal health insurance, while the United States does not. When U.S. patients were categorized according to their insurance status, Canadians had a 44% lower risk of death than did U.S. patients receiving continuous Medicaid or Medicare (95% confidence interval, 0.45-0.71; P less than .001), a 36% lower risk than for U.S. patients receiving intermittent Medicaid or Medicare (95% CI, 0.51-0.80; P = .002), and a 77% lower risk of death than U.S. patients with no or unknown health insurance (95% CI, 0.14-0.37; P less than .001), the investigators said (Ann. Intern. Med. 2017 Mar 14. doi: 10.7326/M16-0858). In contrast, there was no survival advantage for Canadian patients when compared with U.S. patients who had private health insurance. This “[raises] the question of whether a disparity exists in access to therapeutic approaches or health care delivery,” the researchers noted.
This study was supported by the U.S. Cystic Fibrosis Foundation, Cystic Fibrosis Canada, the National Institutes of Health, and the U.S. Food and Drug Administration. Dr. Stephenson reported grants from the Cystic Fibrosis Foundation and fees from Cystic Fibrosis Canada. Several of the study’s other authors reported receiving fees from various sources and one of those authors reported serving on the boards of pharmaceutical companies.
People with cystic fibrosis (CF) survive an average of 10 years longer if they live in Canada than if they live in the United States, according to a report published online March 14 in Annals of Internal Medicine.
Differences between the two nations’ health care systems, including access to insurance, “may, in part, explain the Canadian survival advantage,” said Anne L. Stephenson, MD, PhD, of St. Michael’s Hospital, Toronto, and her associates.
Overall there were 9,654 U.S. deaths and 1,288 Canadian deaths during the study period, for nearly identical overall mortality between the two countries (21.2% and 21.7%, respectively). However, the median survival was 10 years longer in Canada (50.9 years) than in the United States (40.6 years), a gap that persisted across numerous analyses that adjusted for patient characteristics and clinical factors, including CF severity.
One particular difference between the two study populations was found to be key: Canada has single-payer universal health insurance, while the United States does not. When U.S. patients were categorized according to their insurance status, Canadians had a 44% lower risk of death than did U.S. patients receiving continuous Medicaid or Medicare (95% confidence interval, 0.45-0.71; P less than .001), a 36% lower risk than for U.S. patients receiving intermittent Medicaid or Medicare (95% CI, 0.51-0.80; P = .002), and a 77% lower risk of death than U.S. patients with no or unknown health insurance (95% CI, 0.14-0.37; P less than .001), the investigators said (Ann. Intern. Med. 2017 Mar 14. doi: 10.7326/M16-0858). In contrast, there was no survival advantage for Canadian patients when compared with U.S. patients who had private health insurance. This “[raises] the question of whether a disparity exists in access to therapeutic approaches or health care delivery,” the researchers noted.
This study was supported by the U.S. Cystic Fibrosis Foundation, Cystic Fibrosis Canada, the National Institutes of Health, and the U.S. Food and Drug Administration. Dr. Stephenson reported grants from the Cystic Fibrosis Foundation and fees from Cystic Fibrosis Canada. Several of the study’s other authors reported receiving fees from various sources and one of those authors reported serving on the boards of pharmaceutical companies.
FROM ANNALS OF INTERNAL MEDICINE
Key clinical point: People with cystic fibrosis survive an average of 10 years longer if they live in Canada than if they live in the United States.
Major finding: Canadians with CF had a 44% lower risk of death than U.S. patients receiving Medicaid or Medicare and a striking 77% lower risk of death than U.S. patients with no health insurance, but the same risk as U.S. patients with private insurance.
Data source: A population-based cohort study involving 45,448 patients in a U.S. registry and 5,941 in a Canadian registry in 1990-2013.
Disclosures: This study was supported by the U.S. Cystic Fibrosis Foundation, Cystic Fibrosis Canada, the National Institutes of Health, and the Food and Drug Administration. The authors’ financial disclosures are available at www.acponline.org