countries in 2003, the U.S. homicide rate was 6.9 times higher than the other high-income countries and the rate of firearm homicides was 19.5 times higher. Although overall suicide rates were lower in the United States than in those countries, firearm suicide rates were 5.8 times higher than in other countries. Across the 23 countries in the study, 80 percent of all firearm deaths occurred in the United States (Richardson and Hemenway, 2011). This pattern is not new; data from the early 1990s showed similar results (Krug et al., 1998).

Although the incidence of AIDS has fallen since the early 1990s, the United States still has the highest incidence of AIDS among the 17 peer countries (and the third highest in the OECD, exceeded only by Brazil and South Africa) (OECD, 2011b). The incidence of AIDS in the United States (122 per million) is almost nine times the OECD average (14 per million).5

High mortality rates in the United States relative to other rich nations have been the subject of numerous research studies. A 2005 study reported that U.S. adults aged 15-59 had higher mortality rates than those in nine economically comparable nations: “Compared with other nations in the WHO’s mortality database, in the United States 15-year-old girls rank 38th and 15-year-old boys rank 34th in their likelihood of reaching age 60” (Jenkins and Runyan, 2005, p. 291). These researchers noted that the higher mortality was true for both sexes and throughout the first five decades of life (Jenkins and Runyan, 2005).

The U.S. health disadvantage is not limited to death rates; the United States also has relatively high prevalence rates for disease and disability. Chapter 2 details this morbidity disadvantage by age group, but in Box 1-1 we briefly note the key findings that apply across the entire U.S. population.

The United States does enjoy some health advantages compared with other countries. In 2009, the United States had the third lowest mortality rate from stroke among the 17 peer countries (OECD, 2011b), despite its above-average mortality for ischemic heart disease.6 As of 2009, the U.S. suicide rate (10.5 per 100,000 persons) was also below the average of the 16 peer countries (OECD, 2011b). Finally, although the U.S. incidence rate for cancer is the fourth highest of the 17 peer countries (OECD, 2011b),7 mortality rates for certain cancers (e.g., cervical and colorectal cancer) are lower than most peer countries (World Health Organization, 2011a).


5The United States has the fifth highest prevalence of HIV infection among 40 OECD countries, exceeded only by Portugal, the Russian Federation, Estonia, and South Africa (OECD, 2011b), and the highest prevalence of HIV infection (for ages 15-49) among the 17 peer countries (World Health Organization, 2010).

6The reasons for this differential pattern are not entirely clear, but they may relate to cross-national differences in risk factors and treatment for cerebrovascular disease.

7The incidence of cancer may be skewed by the intensity of screening programs in the United States and may not accurately reflect the prevalence of the disease.

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