Associations of multiple evidence-based care strategies with disease mortality, life expectancy, and disparities in the United States.

INTRODUCTION

Limited data exist regarding the potential cumulative effects of multiple, integrated, system-level strategies on population-level outcomes and disparities.

METHODS

We evaluated associations between membership within a multi-disease, integrated population health management model with disease-specific mortality, life expectancy, and demographic disparities and relevant comparators. Bias was minimized through use of a large, representative, multicenter community-based setting, multiple comparators (including similar insured status, same-state, comparable comorbidity distributions, and national), demographic adjustments, and causality criteria.

RESULTS

Among 3 944 173 persons demographics-adjusted mortality was significantly lower for 9 of 10 leading causes of death, including the 5 leading preventable conditions (age-, sex-, race-adjusted risk ratios and 95% CIs Kaiser Permanente, Northern California vs United States [US, all])-cancer (0.85; 0.83-0.88), heart disease (0.69; 0.67-0.71), stroke (0.86; 0.82, 0.91), injury (majority overdoses and falls; 0.45; 0.42-0.48), and respiratory disease (0.59; 0.55-0.63)-but not unmodifiable causes (eg, Alzheimer's disease (1.58; 1.51-1.66). Most life-years gained occurred during ages most impacted by disease-management programs: 50-72 years (>0.075 life-year/year). Life expectancy exceeded comparators and was 4.9 years higher than the US average (83.3 vs 78.4 years, 2023). Findings were robust to index years, multiple other comparator populations, and adjusted analyses. Demographic disparities were smaller across major benchmarks.

CONCLUSION

These findings suggest that high uptake of multiple, existing, evidence-based population health strategies may be cumulatively associated with substantially reduced disease-specific mortality, decreased disparities, and increased life expectancy, comparable to values in comparator countries.