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. 2007 Apr 14;1(1):e27-36.

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

Gordon H Guyatt, Pj Devereaux, Joel Lexchin, Samuel B Stone, Armine Yalnizyan, David Himmelstein, Steffie Woolhandler, Qi Zhou, Laurie J Goldsmith, Deborah J Cook, Ted Haines, Christina Lacchetti, John N Lavis, Terrence Sullivan, Ed Mills, Shelley Kraus, Neera Bhatnagar

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

Gordon H Guyatt et al. Open Med. .

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.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Methodological steps in systematic review
Table 1
Table 1
Summary of findings
Table 2
Table 2
Studies with results favouring the United States
Table 3
Table 3
Studies with results favouring Canada
Table 4
Table 4
Studies with equivalent, equivocal or mixed results
Figure 2
Figure 2
Funnel plot of all-cause mortality, US versus Canadian studies
Table 5
Table 5
Meta-regression including 83 cases from 23 studies
See this image and copyright information in PMC

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