{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:48:30Z","timestamp":1785923310532,"version":"3.56.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Permanente Medical Group"},{"name":"Delivery Science and Applied Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Limited data exist regarding the potential cumulative effects of multiple, integrated, system-level strategies on population-level outcomes and disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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])\u2014cancer (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)\u2014but 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\u201372 years (&amp;gt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag184","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:36:08Z","timestamp":1784028968000},"source":"Crossref","is-referenced-by-count":0,"title":["Associations of multiple evidence-based care strategies with disease mortality, life expectancy, and disparities in the United States"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6132-5165","authenticated-orcid":false,"given":"Douglas A","family":"Corley","sequence":"first","affiliation":[{"name":"Kaiser Permanente Northern California, The Permanente Medical Group , Pleasanton, CA 94588 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5150-5549","authenticated-orcid":false,"given":"Mubarika","family":"Alavi","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, The Permanente Medical Group , Pleasanton, CA 94588 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1652-985X","authenticated-orcid":false,"given":"Bruce H","family":"Fireman","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, The Permanente Medical Group , Pleasanton, CA 94588 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7377-9391","authenticated-orcid":false,"given":"Tori","family":"Finch","sequence":"additional","affiliation":[{"name":"Mid-Atlantic Permanente Research Institute , Washington, DC 20002 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1729-5426","authenticated-orcid":false,"given":"Stephanie","family":"Prausnitz","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, The Permanente Medical Group , Pleasanton, CA 94588 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8385-1027","authenticated-orcid":false,"given":"Smita","family":"Rouillard","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, The Permanente Medical Group , Pleasanton, CA 94588 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7378-777X","authenticated-orcid":false,"given":"Kristine","family":"Lee","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, The Permanente Medical Group , Pleasanton, CA 94588 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7859-3993","authenticated-orcid":false,"given":"Lawrence","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, The Permanente Medical Group , Pleasanton, CA 94588 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Ansari","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, The Permanente Medical Group , Pleasanton, CA 94588 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"2026080505362871900_qxag184-B1","author":"Our World in Data"},{"key":"2026080505362871900_qxag184-B2","author":"National Vital Statistics System (NVSS)"},{"key":"2026080505362871900_qxag184-B3","author":"Centers for Disease Control and Prevention (CDC)"},{"issue":"5","key":"2026080505362871900_qxag184-B4","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1001\/jamainternmed.2025.0155","article-title":"Avoidable mortality across US states and high-income countries","volume":"185","author":"Papanicolas","year":"2025","journal-title":"JAMA Intern Med"},{"issue":"2","key":"2026080505362871900_qxag184-B5","doi-asserted-by":"publisher","first-page":"87","DOI":"10.7812\/TPP\/22.172","article-title":"Comparing Kaiser Permanente members to the general population: implications for generalizability of research","volume":"27","author":"Davis","year":"2023","journal-title":"Perm J."},{"key":"2026080505362871900_qxag184-B6","author":"Care Management Institute at Kaiser Permanente"},{"issue":"1","key":"2026080505362871900_qxag184-B7","doi-asserted-by":"publisher","first-page":"55","DOI":"10.7812\/tpp\/11-134","article-title":"Transparency matters: Kaiser Permanente's National Guideline Program methodological processes","volume":"16","author":"Davino-Ramaya","year":"2012","journal-title":"Perm J"},{"issue":"6","key":"2026080505362871900_qxag184-B8","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.014415","article-title":"Cumulative adherence to secondary prevention guidelines and mortality after acute myocardial infarction","volume":"9","author":"Solomon","year":"2020","journal-title":"J Am Heart Assoc"},{"issue":"7","key":"2026080505362871900_qxag184-B9","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.amjmed.2018.02.014","article-title":"Comparative trends in heart disease, stroke, and all-cause mortality in the United States and a large integrated healthcare delivery system","volume":"131","author":"Sidney","year":"2018","journal-title":"Am J Med"},{"issue":"5","key":"2026080505362871900_qxag184-B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.9723","article-title":"Opioid and naloxone prescribing following insertion of prompts in the electronic health record to encourage compliance with California state opioid law","volume":"5","author":"Duan","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"12","key":"2026080505362871900_qxag184-B11","doi-asserted-by":"publisher","first-page":"4835","DOI":"10.1245\/s10434-020-08897-6","article-title":"Adoption of opioid-sparing and non-opioid regimens after breast surgery in a large, integrated health care delivery system","volume":"27","author":"Patel","year":"2020","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"2026080505362871900_qxag184-B12","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1161\/STROKEAHA.117.018413","article-title":"Novel telestroke program improves thrombolysis for acute stroke across 21 hospitals of an integrated healthcare system","volume":"49","author":"Nguyen-Huynh","year":"2018","journal-title":"Stroke"},{"key":"2026080505362871900_qxag184-B13","author":"National Committee for Quality Assurance (NCQA)"},{"key":"2026080505362871900_qxag184-B14","doi-asserted-by":"publisher","first-page":"E14","DOI":"10.5888\/pcd21.230267","article-title":"Chronic disease prevalence in the US: sociodemographic and geographic variations by zip code tabulation area","volume":"21","author":"Benavidez","year":"2024","journal-title":"Prev Chronic Dis"},{"key":"2026080505362871900_qxag184-B15","author":"Office of Disease Prevention and Health Promotion (ODPHP)"},{"issue":"2","key":"2026080505362871900_qxag184-B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7302a1","article-title":"Preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties, United States, 2010\u20132022","volume":"73","author":"Garc\u00eda","year":"2024","journal-title":"MMWR Surveill Summ"},{"key":"2026080505362871900_qxag184-B17","author":"Centers for Disease Control and Prevention"},{"key":"2026080505362871900_qxag184-B18","author":"Centers for Disease Control and Prevention"},{"key":"2026080505362871900_qxag184-B19","author":"Anderson"},{"issue":"1","key":"2026080505362871900_qxag184-B20","doi-asserted-by":"publisher","first-page":"83","DOI":"10.2307\/2061029","article-title":"Measuring and explaining the change in life expectancies","volume":"21","author":"Arriaga","year":"1984","journal-title":"Demography"},{"issue":"11","key":"2026080505362871900_qxag184-B21","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1038\/bjc.2016.90","article-title":"Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: improving information on the effects of attending screening mammography","volume":"114","author":"Jacklyn","year":"2016","journal-title":"Br J Cancer"},{"issue":"9753","key":"2026080505362871900_qxag184-B22","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1016\/S0140-6736(10)61350-5","article-title":"Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials","volume":"376","author":"Cholesterol Treatment Trialists' (CTT) Collaboration","year":"2010","journal-title":"Lancet"},{"issue":"10305","key":"2026080505362871900_qxag184-B23","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1016\/S0140-6736(21)01921-8","article-title":"Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis","volume":"398","author":"Blood Pressure Lowering Treatment Trialists' Collaboration","year":"2021","journal-title":"Lancet"},{"key":"2026080505362871900_qxag184-B24","author":"Wager"},{"issue":"10","key":"2026080505362871900_qxag184-B25","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.25.0033","article-title":"Using mortality and years-of-life-lost metrics to evaluate health system performance and inform health care policy","volume":"6","author":"McGlynn","year":"2025","journal-title":"NEJM Catal Innov Care Deliv."},{"issue":"16","key":"2026080505362871900_qxag184-B26","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1161\/CIRCULATIONAHA.114.015124","article-title":"Association of race with mortality and cardiovascular events in a large cohort of US veterans","volume":"132","author":"Kovesdy","year":"2015","journal-title":"Circulation"},{"issue":"7","key":"2026080505362871900_qxag184-B27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0253450","article-title":"Health care system efficiency and life expectancy: a 140-country study","volume":"16","author":"Zarulli","year":"2021","journal-title":"PLoS One"},{"issue":"8","key":"2026080505362871900_qxag184-B28","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1200\/JCO.2014.56.8642","article-title":"How do integrated health care systems address racial and ethnic disparities in colon cancer?","volume":"33","author":"Rhoads","year":"2015","journal-title":"J Clin Oncol"},{"issue":"7","key":"2026080505362871900_qxag184-B29","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1001\/jama.2013.108769","article-title":"Improved blood pressure control associated with a large-scale hypertension program","volume":"310","author":"Jaffe","year":"2013","journal-title":"JAMA"},{"issue":"8","key":"2026080505362871900_qxag184-B30","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1056\/NEJMc2112409","article-title":"Association between improved colorectal screening and racial disparities","volume":"386","author":"Doubeni","year":"2022","journal-title":"N Engl J Med."},{"issue":"6","key":"2026080505362871900_qxag184-B31","doi-asserted-by":"publisher","first-page":"424","DOI":"10.7326\/M17-1403","article-title":"The relationship of health insurance and mortality: is lack of insurance deadly?","volume":"167","author":"Woolhandler","year":"2017","journal-title":"Ann Intern Med"},{"issue":"31","key":"2026080505362871900_qxag184-B32","first-page":"666","article-title":"Relationship of income and health care coverage to receipt of recommended clinical preventive services by adults\u2014United States, 2011-2012","volume":"63","author":"Fox","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"10","key":"2026080505362871900_qxag184-B33","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1097\/MLR.0b013e318185c913","article-title":"The causal effect of health insurance on utilization and outcomes in adults: a systematic review of US studies","volume":"46","author":"Freeman","year":"2008","journal-title":"Med Care"},{"issue":"16","key":"2026080505362871900_qxag184-B34","doi-asserted-by":"publisher","first-page":"3125","DOI":"10.1002\/cncr.30722","article-title":"Breast cancer stage variation and survival in association with insurance status and sociodemographic factors in US women 18 to 64 years old","volume":"123","author":"Hsu","year":"2017","journal-title":"Cancer"},{"key":"2026080505362871900_qxag184-B35","author":"Centers for Disease Control and Prevention"},{"key":"2026080505362871900_qxag184-B36","volume-title":"Care Without Coverage: Too Little, Too Late","author":"Institute of Medicine (US) Committee on the Consequences of Uninsurance","year":"2002"},{"issue":"5","key":"2026080505362871900_qxag184-B37","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1177\/003591576505800503","article-title":"The environment and disease: association or causation?","volume":"58","author":"Hill","year":"1965","journal-title":"Proc R Soc Med"},{"key":"2026080505362871900_qxag184-B38","author":"Commonwealth Fund"},{"key":"2026080505362871900_qxag184-B39","author":"National Institutes of Health (NIH)"},{"key":"2026080505362871900_qxag184-B40","author":"Federal Communications Commission, Connect2Health FCC"},{"key":"2026080505362871900_qxag184-B41","author":"Centers for Disease Control and Prevention"},{"key":"2026080505362871900_qxag184-B42","author":"National Committee for Quality Assurance (NCQA)"},{"key":"2026080505362871900_qxag184-B43","author":"Korshak"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag184\/70248373\/qxag184.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/8\/qxag184\/70248373\/qxag184.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/8\/qxag184\/70248373\/qxag184.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:36:35Z","timestamp":1785922595000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag184\/8743946"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":43,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,3]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag184","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,28]]},"article-number":"qxag184"}}