As a person with a degree in Math (and who works in the data mining industry), reading the article from CNN seemed to create more questions than it answered. The article said that, for women, there was no difference in survival rates. That would suggest that insurance and nutrition didn't factor in AT ALL. But then the article says that insurance is a big factor, and theat the difference goes away when you remove US patients on Medicare/Medicaid. Later, the article tells how the big differences starting appearing when the U.S. changed to a new method of determining which patients on the lung transplant list got new lungs first, and that CF patients seem to be getting the short end of the stick. As a data miner, these things and the others mentioned in the article suggest to me that more analysis seems to be needed on this data. Two independent variables (gender and insurance) should not BOTH cause the gap to disappear when you correct for those variables. The likelihood of that is really low, unless gender and insurance coverage are somehow related. Honestly, if I were working on a project and this kind of result happened, I would tell my boss that we don't yet really have a clue what's going on here, and we need a lot more analysis to be done before we can give any intelligent assessment of what's going on. I wouldn't release ANY information to the press when those kind of conflicting results are happening. I'm glad one of the doctors in the article said that more research was needed. You have to let the data tell you the truth, and whatever it tells you is good. It seems to me they should have figured this out better before letting a journalist run with it. My biggest takeaway from this is that we need to ask the CF Foundation in the U.S. to go to bat for us and make sure that a person with CF who might live 30 extra years with a transplant is not getting passed over because of their transplant score and the lungs given to a 70-year-old lifelong smoker (who caused their own health problems) who will only live 5 extra years with the lungs.
Interesting comments DanfromIL. Frankly, I didn't really pick up on the concept that the disparity in longevity was eliminated when the comparisons were isolated to women. Can you give me a quote on that? (That's not meant as a challenge to your premise, just a shortcut for me!) But, I'm diverting from my current concern.
Obviously they need a lot more research. What struck me as intriguing, though, was that the disparity was eliminated when adjusted for the type of insurance plan. Whoa. Those individuals on PRIVATE health insurance lived as long as our Canadian brethren. The disparity appeared when those on Medicaid/Medicare were entered into the equation. Now that's scary. First of all, we're facing the possibility of decreasing eligibility for Medicaid (if I understand the current proposed legislation - which I really feel needs more study on my part, I confess). Now the CFF has come out against doing that. I really trust the CFF. I want to know more. But if the study concerning Canada is correct, it suggests we really DO need to move people off Medicaid to private health insurance (although I can't imagine how we do that without decreasing coverages or increasing premiums.) But why does insurance through Medicaid decrease your life expectancy? I can think of a number of reasons for this - all quite unscientific I suspect and doubtlessly there are a whole lot more reasons that others may imagine - which I'd love to hear. But let me take at least one shot at this.
It really is a given that people at or below the poverty line (Medicaid eligible) have worse health, receive less healthcare, and more often suffer unaddressed health issues. They are at risk of poorer nutrition, more often have less or inferior education, and access even available healthcare less often even when covered under Medicaid. The causes are another chase down the hole to Wonderland. This may be a discussion for a sociologist, but I suspect in no small part it is due to more transportation issues, employment issues, stress, depression, isolation, poor education etc. All classic partners in poverty. And more specifically, I wonder about less adherence to the stiff regimens required by CF as a result of all of the above.
But of course, there are poor people in Canada too aren't there? So wouldn't that even things out? Actually, not likely. The percentage of poor in Canada is significantly lower than the United States, if my internet sources are correct, although the extent of poverty, especially among children, in both countries is shameful. Canada appears to be more successful in bootstrapping their poor into middle class living, whether it be through greater subsidies, better employment opportunities, better education, or other factors.
We cling to Medicaid because historically people with chronic illnesses/pre-existing conditions could not get private insurance or because, if they could, the cost in premiums, deductibles, copays and lifetime maximums were prohibitive. (Obamacare doesn't seem to have fixed all that - I know whole families who still don't have insurance because they can't afford the market - they risk fines instead.) But at least Medicaid would pay for care if you use it - religiously. Ah. . . . sort of.
The unhealthy circumstances of the impoverished are not the only explanation I see. I have had my child in both the private insurance and Medicaid systems. Frankly, under private insurance my co-pays per month were horrendous. Even with low percentages and competitive maximum out of pockets. There were so many meds that even low copays added up to a fistful of dollars. BUT, I rarely had issues with coverages - not for meds, or procedures or doctor visits. I didn't have to argue about generics (which I believe allow the drug manufacturer to vary the operative ingredient by up to 10%). If I wanted a name brand for some reason, I got it. If he needed an expensive piece of equipment (read this as his vest) it was quickly provided by the recommended manufacturer). No arguments, no try this other drug first approaches, etc. Those kinds of roadblocks occurred on occasion, yes. But compared to Medicaid? OMG. Medicaid will take all your energy to navigate and all your time. They wear you down. I never wound up missing meds or unable to get what we needed on private health insurance - but that was the norm on Medicaid. Prior-authorizations alone adds hundreds of thousands to health care costs each year for every provider group. I remember only one occasion when there was a glitch in the private policies coverage of dental issues that they refused a quick dental surgery and wanted to force repeated painful visits in the dental chair instead. Medicaid covered the surgery without argument. But that was the only time Medicaid made more sense. Instead my kiddo has missed TOBI for weeks because Medicaid couldn't find their butts with both hands. They've forced him to try Albuterol instead of Xopenex repeatedly despite his historically violent reaction to the former. They refused to let me even outright BUY WITH MY OWN MONEY extra nebulizer cups so I didn't have to try to sterilize the same dang one four times a day with a boiling pot of water and a hairdryer. I'm sorry - but government run health insurance is nuts. It will keep you alive. We are very fortunate that it will cover almost all prescribed drugs at least in one form or another (not the Canadian experience). BUT, unless you have the stamina and determination - which many at the Medicaid level do not - I suspect they do not enable the same level of healthcare that private insurance in the United States has historically provided - even though it's possible. I have a worn notebook of my arguments with Medicaid.
So. Perhaps the disparity in longevity between Medicaid recipients and those covered by private healthcare isn't so confounding. Frankly, it also occurs to me that women are more likely to press through the barriers that Medicaid provides than men. More likely to pay attention to the rigors of CF maintenance. More likely to pay attention to their health, overall. Ok. That was sexist? But . . . true?
I really don't know. But perhaps my stream of consciousness may help someone out there reading get us closer to figuring this out. I dream of an explanation.