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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

Studies with results favouring Canada
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table3: Studies with results favouring Canada

Mentions: The first of the low-quality studies favouring the US presented results from administrative databases in the United States and Ontario and showed similar survival in patients with colon and lung cancer and Hodgkin’s lymphoma, but superior survival in American breast cancer patients.18 Another study using the same databases over a somewhat different (but overlapping) period showed similar results for breast cancer and Hodgkin’s disease, but found an overall survival advantage for American patients in colon cancer and Canadian patients in lung cancer19 (Table 4). Two studies that used the same database but restricted their analysis to Toronto versus American cities that the authors considered comparable showed a significant advantage20 or a trend21 toward superior survival in breast cancer patients in Canada versus the United States (Table 3).


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)

Studies with results favouring Canada
© Copyright Policy - open-access
Related In: Results  -  Collection

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

table3: Studies with results favouring Canada
Mentions: The first of the low-quality studies favouring the US presented results from administrative databases in the United States and Ontario and showed similar survival in patients with colon and lung cancer and Hodgkin’s lymphoma, but superior survival in American breast cancer patients.18 Another study using the same databases over a somewhat different (but overlapping) period showed similar results for breast cancer and Hodgkin’s disease, but found an overall survival advantage for American patients in colon cancer and Canadian patients in lung cancer19 (Table 4). Two studies that used the same database but restricted their analysis to Toronto versus American cities that the authors considered comparable showed a significant advantage20 or a trend21 toward superior survival in breast cancer patients in Canada versus the United States (Table 3).

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