美國人健康狀況不容樂觀
報道 2013年01月11日
據美國一份新近發佈的健康及壽命分析報告顯示，與其他發達國家的同齡人相比，美國年輕人的預期壽命更短，健康狀況也更差，槍支暴力、車禍和毒癮導致的死亡率也更高。
一段時間以來，研究人員已經知道，和其他富裕國家相比，美國人的健康狀況不那麼好，這一趨勢形成於20世紀80年代。不過，大部分健康和壽命研究都集中在老年人，這個高死亡率人群。
研究結果相當嚴峻。美國男性的預期壽命，與其他16個發達國家男性的預期壽命之間的差距，有三分之二是由於50歲之前死亡導致的，而女性在預期壽命上的差異有三分之一是由於50歲之前死亡導致的。分析包括的國家有加拿大、日本、澳大利亞、法國、德國和西班牙。
這份長達378頁的研究報告由美國醫學研究院(Institute of Medicine)和全國研究委員會(National Research Council)召集的一個專家小組編寫。它是第一份系統比較包括美國年輕人在內的各年齡段人群的死亡率及健康指標的報告。和其它研究相比，它更加全方位地研究了包括疾病、事故和暴力在內的各種死亡原因。專家組針對死亡率、健康研究和統計數據展開了大量研究，得出了上述結論。
研究小組把這種高患病率及更短壽命的規律性現象稱為"美國健康劣勢"，說這是過去30年來美國人預期壽命墊底的原因。研究顯示，美國男性預期壽命在17個國家裡位列倒數第一，美國女性預期壽命則位列倒數第二。
研究小組負責人、弗吉尼亞聯邦大學(Virginia Commonwealth University)家庭醫學系(Department of Family Medicine)主任史蒂文·伍爾夫(Steven Woolf)醫生說，"出了一些根本性問題。這不是某屆政府或某個政黨造成的。某些核心問題正導致美國落後於其他那些高收入國家。而且情況還在惡化。"
車禍、槍支暴力和吸毒過量是讓美國人在50歲之前死亡的主要原因。
報告援引2011年對23個國家進行的研究披露，在美國，持槍殺人案件比其他國家多出20倍。雖然美國的自殺率較低，但槍械自殺的比率比其他國家高六倍。
研究透露，美國2007年的殺人案中有69%的案件涉及槍支，其他國家這一比例平均只有26%。
研究小組成員、賓夕法尼亞大學(University of Pennsylvania)人口學家兼社會學家塞繆爾·普雷斯頓(Samuel Preston)表示，"總而言之，我們不能防止健康問題上的有害行為。你可以怪罪公共衛生官員或醫療體系。沒有人明白責任應該由誰來負。"
美國人在各項指標上都墊底，令專家感到吃驚。美國人因普通心臟病導致的死亡率在各國中為第二高，肺病死亡率也位居第二，這是過去10年高吸煙率的後果。美國成年人的糖尿病患病率也是最高的。
年輕人的情況也不樂觀。美國是被調查的國家中嬰兒死亡率最高的國家，美國年輕人患性傳播疾病的比率、青少年懷孕率和車禍死亡率也是最高的。美國人50歲以前因酗酒和吸毒導致死亡的也比其他國家更多。
美國人活到50歲的機率也是各國中最低的。報告的第二章詳細羅列了年輕人的各項健康指標，美國青年的排名不是在最後，就是接近最後。健康指標的內容繁多，佔了整整四頁。對50歲一下人群而言，心臟病等慢性疾病也是影響壽命的因素之一。
"我們以為會看到一些壞消息和一些好消息，"伍爾夫博士說，"但是美國人幾乎在每項健康指標上的排名都在最後或接近最後，這讓我們感到吃驚。"
還有一些積極信息。美國能通過檢測發現的癌症（如乳腺癌）的致死率比較低。成年人對膽固醇和高血壓的控制較好。而且最年長的美國人，即75歲以上的老人，通常會比其他國家的同齡人更加長壽。
研究小組試圖解釋美國人健康狀況欠佳的原因。它指出，美國的醫療保健系統非常支離破碎，基礎醫療資源很有限，還有很多人不在保障範圍內。在研究對象國中，美國的貧困率最高。
教育也是一個原因。伍爾夫說，美國高中未畢業的人死於糖尿病的比率是受過大學教育的人的三倍。報告還稱，其他國家有更加慷慨的社會保障體系，降低了貧困導致的健康方面問題對家庭的傷害。
儘管如此，最有可能身體健康的人群，如受過大學教育和高收入的美國人，在很多健康指標上的表現也比較差。
For Americans Under 50, Stark Findings on Health
January 11, 2013
Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States.
Researchers have known for some time that the United States fares poorly in comparison with other rich countries, a trend established in the 1980s. But most studies have focused on older ages, when the majority of people die.
The findings were stark. Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the United States and their counterparts in 16 other developed countries, and about one-third of the difference for females. The countries in the analysis included Canada, Japan, Australia, France, Germany and Spain.
The 378-page study by a panel of experts convened by theInstitute of Medicine and the National Research Councilis the first to systematically compare death rates and health measures for people of all ages, including American youths. It went further than other studies in documenting the full range of causes of death, from diseases to accidents to violence. It was based on a broad review of mortality and health studies and statistics.
The panel called the pattern of higher rates of disease and shorter lives "the U.S. health disadvantage," and said it was responsible for dragging the country to the bottom in terms of life expectancy over the past 30 years. American men ranked last in life expectancy among the 17 countries in the study, and American women ranked second to last.
"Something fundamental is going wrong," said Dr. Steven Woolf, chairman of the Department of Family Medicine at Virginia Commonwealth University, who led the panel. "This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it's getting worse."
Car accidents, gun violence and drug overdoses were major contributors to years of life lost by Americans before age 50.
The rate of firearm homicides was 20 times higher in the United States than in the other countries, according to the report, which cited a 2011 study of 23 countries. And though suicide rates were lower in the United States, firearm suicide rates were six times higher.
Sixty-nine percent of all American homicide deaths in 2007 involved firearms, compared with an average of 26 percent in other countries, the study said.
"The bottom line is that we are not preventing damaging health behaviors," said Samuel Preston, a demographer and sociologist at the University of Pennsylvania, who was on the panel. "You can blame that on public health officials, or on the health care system. No one understands where responsibility lies."
Panelists were surprised at just how consistently Americans ended up at the bottom of the rankings. The United States had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. American adults also have the highest diabetes rates.
Youths fared no better. The United States has the highest infant mortality rate among these countries, and its young people have the highest rates of sexually transmitted diseases, teen pregnancy and deaths from car crashes. Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries.
Americans also had the lowest probability over all of surviving to the age of 50. The report's second chapter details health indicators for youths where the United States ranks near or at the bottom. There are so many that the list takes up four pages. Chronic diseases, including heart disease, also played a role for people under 50.
"We expected to see some bad news and some good news," Dr. Woolf said. "But the U.S. ranked near and at the bottom in almost every health indicator. That stunned us."
There were bright spots. Death rates from cancers that can be detected with tests, likebreast cancer, were lower in the United States. Adults had better control over theircholesterol and high blood pressure. And the very oldest Americans — above 75 — tended to outlive their counterparts.
The panel sought to explain the poor performance. It noted the United States has a highly fragmented health care system, with limited primary care resources and a large uninsured population. It has the highest rates of poverty among the countries studied.
Education also played a role. Americans who have not graduated from high school die from diabetes at three times the rate of those with some college, Dr. Woolf said. In the other countries, more generous social safety nets buffer families from the health consequences of poverty, the report said.
Still, even the people most likely to be healthy, like college-educated Americans and those with high incomes, fare worse on many health indicators.
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