Sometimes, the culprit may reside indoors. It has been observed that antigens released by decaying cockroach carcasses pose the highest risk for the development of childhood asthma in many of our inner-city neighborhoods.4 Merely focusing on outdoor air quality will not fix this issue for these children.
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Explore This IssueJuly 2017
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On a broad scale, one’s community exerts a profound effect on one’s longevity. Indeed, it matters where you live. The U.S. counties with the longest life expectancy are affluent areas with high per capita incomes, such as Marin County, Calif., and Summit County, Colo., whereas Oglala Lakota County, S.D., which includes the Pine Ridge Native American reservation, many counties clustered along the lower Mississippi River Valley and parts of West Virginia and Kentucky have the shortest life expectancy, with the difference exceeding 20 years (87 vs. 67 years). This worrisome national gap in life expectancy resembles the difference observed between Japan, an advanced nation, and India, a developing one.5 There is no sign of the American gap closing; in fact, from 1980 to 2014, it increased by an additional two years.
A Costly Paradox
Because the U.S. can be divided into distinct geographic regions, may there be distinct variations in healthcare consumption and its cost in each of these areas? Considerable data have been amassed, demonstrating that the quality and cost of medical services vary wildly in different parts of the country.6 A report commissioned by Blue Cross and Blue Shield, an organization of insurers that covers about one-third of Americans, analyzed three years of claims data from 64 markets. Researchers found that knee replacement surgery is most expensive along the Eastern and Western seaboards, the Great Lakes and parts of Texas, and it’s least costly in the farm belt and the Rocky Mountain states.
But the data reveal a more curious observation: Within each of these regions stark differences in the cost of care exist. Although the national average list price for knee joint arthroplasty surgery was $31,124, this number is meaningless considering that the standard deviation of prices was so wide. In Dallas, the cost of the identical procedure varied between $16,772 and $61,585. In Boston, a city where nothing is cheap, the price of a total hip replacement varied four-fold, between $17,910 and $73,987. Perhaps I should advise my patients to fly down to Birmingham Ala., where the cost of the same hip procedure averages a paltry $11,327. Throw in a stay at a five-star hotel and a couple of tickets to see the Crimson Tide play football and you have an amazing deal!