title: A systematic review of studies comparing health outcomes in Canada and the United States.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: Pj
authors.initials: P
authors.lastname: Devereaux
authors.forename: Joel
authors.initials: J
authors.lastname: Lexchin
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Stone
authors.forename: Armine
authors.initials: A
authors.lastname: Yalnizyan
authors.forename: David
authors.initials: D
authors.lastname: Himmelstein
authors.forename: Steffie
authors.initials: S
authors.lastname: Woolhandler
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhou
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Goldsmith
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Ted
authors.initials: T
authors.lastname: Haines
authors.forename: Christina
authors.initials: C
authors.lastname: Lacchetti
authors.forename: John N
authors.initials: JN
authors.lastname: Lavis
authors.forename: Terrence
authors.initials: T
authors.lastname: Sullivan
authors.forename: Ed
authors.initials: E
authors.lastname: Mills
authors.forename: Shelley
authors.initials: S
authors.lastname: Kraus
authors.forename: Neera
authors.initials: N
authors.lastname: Bhatnagar