Carnegie Mellon researchers link health-care debate to risk of dying in US and Europe

Lifestyle choices vs. life expectancy

PITTSBURGH—The current health care debate in the United States is complicated. Trade-offs between heath care expenditures, lifestyle choices and life expectancy have been suggested but seldom clearly demonstrated. The U.S. spends on average more than $45,000 per year on health care for every 80 year old, while the Europeans spend $12,000 for the same age group. U.S. octogenarians have a 20 percent less chance of dying than Europeans in the next year. But, more than 30 percent of the U.S. population is obese, compared to less than 10 percent of Europe's population.

"Many of the lifestyle choices that we make as adults have negative health consequences," said Paul Fischbeck, professor of social and decision sciences and engineering and public policy at Carnegie Mellon University. "But once we reach retirement age, it appears that differences in the medical systems start to favor the U.S."

The costs of U.S. policy are staggering. If the U.S. had the same per capita health expenditures for retirees as Germany or the United Kingdom, our country's total health care costs for all citizens would be about 40 percent less.

"The differences between U.S. and Europe in health care expenditures could not be starker," Fischbeck said. "Starting at age 65, per capita U.S. expenditures skyrocket, resulting in many hundreds of billions of dollars being spent over our European counterparts after matching population sizes."

Tough health care policy decisions revolve around cost-benefit trade-offs. A variety of factors would have to be weighed if the country shifted the emphasis from care for the elderly to polices that favor earlier preventive and lifestyle choices.

"A shift in policy could lead to more people reaching age 65, but once there, facing a higher chance of dying," Fischbeck said. "In fact, if the U.S. had Germany's death rates, we would see 150,000 more annual deaths of those over 80."

A new Web site, www.DeathriskRankings.com, developed by researchers and students at Carnegie Mellon allows users to explore differences in the probability of dying across European countries and U.S. states for men and women of different ages and races.

"When our risk data is coupled with health care cost estimates from other sources, surprising results are found," Fischbeck said. "It is only by comparing the reduction of risk associated with the additional costs that good policy choices can be made."

The research shows that prostate cancer, which has few lifestyle risk factors, is a much greater killer in Europe. In 11 European countries (including Sweden, Norway, Switzerland, Denmark, Netherlands and the United Kingdom) a man in his 70s has a higher chance of dying from prostate cancer than a man in Mississippi, the U.S. state with the highest risk. When compared to residents of Hawaii, the U.S. state with the lowest prostate cancer risk, Europeans are two to three times more likely to die from prostrate cancer.