Comment by barrkel | Hacker News Reader

Comment by barrkel | Hacker News Reader

Parent Full thread

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.

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 #56 (higher numbers are better), ahead of basically the entire EU, on colorectal cancer mortality.

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.

But even by what you write, it's not convincing, though, is it? Behind some major countries on a number of common cancers, but in the lead on others. I mean, it's clear that the US is not lagging. But it's not a convincing lead either. And you need to look at the variances. From looking at the per 100K deaths, many of the US leads are in the region of 10%, but the variances between different European countries is much larger than that.

But the US is definitely in the lead on breast cancer. No doubt about that.

Correlate the cancers in which the US is ahead of 2 out of 3 of France, Germany, and the UK, to the cancers that kill the most people (incidence and mortality). Pull out lung cancer, for which there is a clear causal explanation.

Now compare that result to life expectancy rankings. That's the point I'm making.

Do Europeans really smoke less than Americans? I was under the impression that the US was unusually anti-smoking.

Cigarette advertising is still legal in the USA right? And a packet of cigarettes costs less than an hours work at minimum wage because the taxes aren't that high, right?

No, and no. Also, it's invariably illegal to smoke indoors or within 10 feet of a building entrance. And there is constant anti-smoking propaganda. And people on the street will make negative comments about you smoking.

The other thing to consider is how the causes of death interact, and who it is that's contributing to mortality/survival rates. For example, perhaps people in France have higher cancer mortality rates because they are not dying from heart disease at a younger age. Perhaps the US has better survival rates for cancer because the incidence rates are higher among lower age groups, and people's general health is better at those ages, and so on.

Reply on news.ycombinator.com