Canadians With Cystic Fibrosis Live 10 Years Longer Than Americans With Disorder
Chalk up another positive for Canada’s universal health care just when the U.S. is wrangling over what to do about health care down south.
A new study shows that, although all people with cystic fibrosis are living longer than ever before, their lifespan is almost 10 years longer in Canada than in the United States, according to research published in the Annals of Internal Medicine.
The median age of survival for individuals with cystic fibrosis in Canada is 50.9 years compared to 40.6 years in the United States, said Dr. Anne Stephenson, a respirologist and cystic fibrosis researcher at St. Michael’s Hospital in Toronto, which has the largest adult CF clinic in Canada.
Also, after taking into account factors such as age and the severity of the disease, the risk of death among people with cystic fibrosis was 34 per cent lower in Canada than in the United States.
The study was funded by the U.S. Cystic Fibrosis Foundation using data from 45,456 patients in the U.S. Cystic Fibrosis Foundation Registry and 5,941 patients in the Canadian Cystic Fibrosis Registry from 1990 to 2013. The 10-year difference in lifespan was based on data from the last five years of the study, 2009 to 2013.
Although the study was not designed to explain why the lifespan differs in the two countries, Dr. Stephenson said there were several possible reasons: medical insurance, transplants and diet.
“Survival has increased in both countries, but Canada began to see greater improvements than the United States starting in 1995, with an even more dramatic increase in the survival rate in Canada noted in 2005,” she said.
Health care coverage
There was no difference in survival rates between U.S. patients with private health insurance compared to Canadians. However, Canadians had a 44 per cent lower risk for death than U.S. patients receiving continuous Medicaid or Medicare, a 36 per cent lower risk than those receiving intermittent Medicaid or Medicare, and a 77 per cent lower risk than those with unknown or no health insurance.
Lung transplantation is one of the few treatments for cystic fibrosis that can positively impact survival almost immediately and a higher proportion of CF patients received a transplant in Canada than in the United States during the study period. The survival difference increased dramatically in 2005 which coincided with the year that the United States began using a lung allocation score to prioritize people on the lung transplant waiting list. This score is not used in Canada raising the possibility that this difference may be contributing to the survival gap seen.
Canadians with cystic fibrosis were exposed to a high fat diet in the 1970s, which was not implemented in the United States until the 1980s. In people with cystic fibrosis, higher caloric intake results has been linked to improved survival. Individuals born in the 1970s and exposed to good nutrition from birth could explain why Canadian survival rates saw improvement in 1995.