The probable genetic explanation for interstate differences in mortality amongst non-hispanic whites

A couple months ago I stumbled across ancestry.com’s  “Genetic Census of America”.  Since I was researching the health outcomes question already I remembered that this data existed and I decided to bite the bullet and actually analyze this data systematically.  Lo and behold, I quickly discovered some very strong correlations between these genetic proportions (crudely without any particular techniques) and the life expectancy of non-hispanic whites in each state.  I refined this a bit and produced a toy model that can explain about 85% of the variance in life expectancy between states (not to mention other things)!

Before I get started, let me get some caveats out of the way:

• correlation does not necessarily imply causation
• these particular genetic groups may just be proxies in this country for particular ethnic or other genetic groups (at least in part)
• this could “cultural” (people with particular frequencies of SNPs are also more likely to have had particular cultural mores, values, and the like passed onto them through their ancestors/parents).
• most “whites” have some fraction of other continental groups, but it’s usually pretty small on average
• the DNA testers may not necessarily be representative of the larger “white” population, but I think it’s good enough to represent the white population (probably less so other groups).
• binning these together by states and other high levels of aggregation likely improves the “accuracy” of these methods since random accidents, stochastic variances in gene expression, or what have you get averaged out to large degree.  Likewise, to the extent these groups are just a crude proxy for actual groups, this level of aggregation likely further helps.
• Ancestry.com does not provide details by race/ethnic group and my procedures cannot perfectly remove any potential signature introduced by others.   Blacks and latinos, in particular, surely introduce some european genetic groups into this data, although they are obviously much under-represented in ancestry’s DNA analysis and I do not think it would skew the results that much.

This is a simple model that I produced to calculate non-hispanic white (NHW) life expectancy by state using a simple genetic calculation and smoking rates (weighted equally on standard deviations from the national non-hispanic mean amongst states) .

As for how I got here….

Some other issues with comparing US healthcare costs and so-called “outcomes”

Besides my previously mentioned objections with simplistic comparisons between healthcare systems, vis-a-vis naive economic comparisons and the effect of taxation on behaviors, it is very difficult to compare the actual performance of healthcare systems, in both financial and human terms (e.g., life expectancy, mortality rates, etc), without accounting for other differences in the populations (e.g., genetics, health/risk behaviors, lifestyle, etc).   These simplistic comparisons of national health care systems based on crude mortality rates and the like are very much like comparing performance of goalies in various sports based on who wins the game alone, i.e., without making any real attempt to control for the performance of the rest of the teams’ defense, the performance of the offense, and so on, when what we really want to know, at bare minimum, is the number of saves as compared the number of shots on goal (and even then that’s an imperfect metric).  Of course some goalies are likely to be somewhat more effective than others and, other things equal, goalies can have a pronounced impact on the outcomes, but you cannot simply assume that there are not any significant systematic differences between teams in general or on game day.

These are just a few relevant differences I can think of off the top of my head:

• The United States population is not a mirror image of Europe: genetically, culturally, or otherwise
• Much higher smoking rates historically
• Relatively high rates of obesity (although other countries are starting to catch up to us now)
• Much higher homicide rate.
• Higher rates of sexually transmitted diseases (see the AIDS crisis)
• More geographically distributed than most (as in, lower population density, significant populations living in rural locations, etc)
• Higher rates of serious automobile accidents per capita

….. (and probably more I’m forgetting)

National Healthcare Expenditure: United States versus Other Countries: The US is not really an outlier.

Numerous people have asserted that the United States spends dramatically more on healthcare than other countries, presumably even more than countries of our level of wealth and affluence, and that this can only be explained by the fact that we do not have single-payer or some such.

Here are some examples graphs used to make this point

These appear to be very convincing at first blush, but i never found these arguments particularly convincing due primarily to:

1. Imperfect comparability between the selected countries
2. Issues relating to comparing countries of the “same” GDP
3. cherry-picking of countries

I knew the proponents of single-payer were, at best, making an incomplete argument and that it invited an exaggerated impression of what we should likely expect from a country like ours, but, up until now, I lacked the data and the time to present these argument comprehensively.  I recently got in an argument with someone over this subject and found a treasure trove of data all in one place (mostly) to thoroughly debunk this overly simplistic argument.

To make my points, vis-a-vis fundamental issues with naive treatment of GDP per capita and sensitivity to comparison countries, here is a quick chart showing National Healthcare Expenditure (NHE) as a percent of GDP by GDP per capita

 

United States physician income in context

One of the issues that I have when people assert that United States physician compensation is much higher than other countries is that they make terribly naive comparison.  They compare, say, PPP-adjusted incomes to PPP-adjusted incomes in other countries without accounting for the fact that the “average” person in this country has a much higher PPP-adjusted income by most measures.   Likewise, they’ll compare physician income to “average income” or “average wage” ratios without comparing it to the more relevant labor pool in each country, i.e., at least college graduates (or better). example

Average Physician Gross Income to Average College Grad Gross Income [apples-to-apples]

Note: In both cases, “gross” is pre-tax income, including social security/payroll contributions.

Real physician income data from the OECD

OECD report on physician incomes

 

General Practioner Real Incomes

See: Page 18 (Figure 83)

The growth rate of healthcare inflation

Many people are under the mistaken impression that healthcare spending is a “solved” problem in the rest of the world and that their rate of “inflation” is under control or, at least, under much better control than ours.

This is simply incorrect.

Below is a chart illustrating PPP-adjusted per capita healthcare spending in the United States and other selected countries between 1990 and 2009 (almost twenty years).

source

As you can clearly see we’re pretty solidly in the middle of the pack and no one has even come close to “solving” said inflation.