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A systematic review of studies comparing health outcomes in Canada and the United States.

Guyatt GH, Devereaux P, Lexchin J, Stone SB, Yalnizyan A, Himmelstein D, Woolhandler S, Zhou Q, Goldsmith LJ, Cook DJ, Haines T, Lacchetti C, Lavis JN, Sullivan T, Mills E, Kraus S, Bhatnagar N - Open Med (2007)

Bottom Line: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity.Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

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ABSTRACT

Background: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.

Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.

Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.

Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

No MeSH data available.


Related in: MedlinePlus

Funnel plot of all-cause mortality, US versus Canadian studies
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figure2: Funnel plot of all-cause mortality, US versus Canadian studies

Mentions: The statistical analysis was based on results of 83 populations in 23 studies that reported all-cause mortality with sufficient completeness for inclusion.15-18, 20-23, 25-27, 29, 33, 37-40, 42, 43, 46, 47, 50 In Figure 2, which depicts the distribution of the log of the relative risk against the precision of the estimates (the inverse of the standard deviation of the log RR), values to the left of 0 favour Canada and values to the right of 0 favour the United States. The pooled relative risk of dying in Canada versus the United States was 0.95 (95% CI 0.92 to 0.98, p = 0.002, heterogeneity p < 0.0001, I2 = 0.94). The plot suggests some asymmetry, with a number of low-precision studies favouring Canada without corresponding studies favouring the United States. This is consistent with the statistical analysis, which suggested rejecting the hypothesis of no asymmetry (p = 0.02). One possible explanation for this result is publication bias in Canada’s favour.


A systematic review of studies comparing health outcomes in Canada and the United States.

Guyatt GH, Devereaux P, Lexchin J, Stone SB, Yalnizyan A, Himmelstein D, Woolhandler S, Zhou Q, Goldsmith LJ, Cook DJ, Haines T, Lacchetti C, Lavis JN, Sullivan T, Mills E, Kraus S, Bhatnagar N - Open Med (2007)

Funnel plot of all-cause mortality, US versus Canadian studies
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2801918&req=5

figure2: Funnel plot of all-cause mortality, US versus Canadian studies
Mentions: The statistical analysis was based on results of 83 populations in 23 studies that reported all-cause mortality with sufficient completeness for inclusion.15-18, 20-23, 25-27, 29, 33, 37-40, 42, 43, 46, 47, 50 In Figure 2, which depicts the distribution of the log of the relative risk against the precision of the estimates (the inverse of the standard deviation of the log RR), values to the left of 0 favour Canada and values to the right of 0 favour the United States. The pooled relative risk of dying in Canada versus the United States was 0.95 (95% CI 0.92 to 0.98, p = 0.002, heterogeneity p < 0.0001, I2 = 0.94). The plot suggests some asymmetry, with a number of low-precision studies favouring Canada without corresponding studies favouring the United States. This is consistent with the statistical analysis, which suggested rejecting the hypothesis of no asymmetry (p = 0.02). One possible explanation for this result is publication bias in Canada’s favour.

Bottom Line: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity.Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.

Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.

Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.

Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

No MeSH data available.


Related in: MedlinePlus