As part of an ongoing effort to evaluate alternative treatments for benign prostatic hyperplasia, we compared the outcomes of transurethral resection of the prostate with those of open prostatectomy. Men undergoing prostatectomy in Denmark (n = 36,703), Oxfordshire, England (n = 5284), and Manitoba, Canada (n = 12,090), were identified retrospectively through administrative data and followed for up to eight years. The cumulative percentage of patients undergoing a second prostatectomy was substantially higher after transurethral than after open prostatectomy (12.0 vs. 4.5 percent in Denmark, 12.0 vs. 1.8 percent in Oxfordshire, and 15.5 vs. 4.2 percent in Manitoba). The long-term age-specific mortality rates associated with transurethral prostatectomy as compared with open prostatectomy were also elevated in each country. The data on 1650 Canadian patients were used to investigate the contribution of coexisting morbid conditions to the elevated risk of death. The relative risk was 1.45 (95 percent confidence interval, 1.15 to 1.83) before risk adjustment and 1.45 (95 percent confidence interval, 1.15 to 1.84) after adjustment; the higher mortality was seen among low-risk as well as high-risk patients. These findings suggest that transurethral prostatectomy is less effective in overcoming urinary obstruction than the open operation. Our data also raise the possibility that transurethral prostatectomy may result in higher long-term mortality, although we cannot rule out potential confounding effects of unmeasured characteristics of patients.

The application of ACGs in Canada is feasible using existing data. The ability of the ACG system to explain variation in costs is similar to that found in US health systems. While application of ACGs in Canada shows promise, further research is required to examine how closely they reflect population morbidity burdens and health care needs.

Health varies with socioeconomic status; those with higher incomes or who are better educated can expect to have better health. The success of the Canadian universal health care system in delivering care according to need was assessed. Consistent gradients in all‐cause and cause‐specific mortality according to neighborhood income characteristics are evident among Winnipeg residents. Poorer, less healthy groups receive more acute hospital care and have more contacts with general practitioners. Surgical rates and contacts with specialist physicians, however, show less variation by socioeconomic status. One reason may be that members of higher socioeconomic groups have the skills required to negotiate for surgery when they develop conditions, like joint pain, that are less critical. The move toward organized priority lists in Canada may remedy this situation. As access to health care is more equalized, improvement in the health of lower and middle socioeconomic groups will occur through changes in social policy like improvement of educational opportunities.

In Manitoba, Canada, a representative cohort of elderly individuals ages 65 to 84 (n = 3,573) were interviewed in 1971 and the survivors of this cohort were reinterviewed in 1983. This analysis assesses the determinants of successful aging--whether or not an individual will live to an advanced age, continue to function well at home, and remain mentally alert. Over 100 separate indicators of demographic and socio-economic status, social supports, health and mental status in 1971 were available as potential predictors of successful aging. Indicators of access to health care over the period 1970-82 and indicators of diseases over this period were also available as predictors. Those who aged successfully were shown to have greater satisfaction with life in 1983 and to have made fewer demands on the health care system than those who aged less well. Despite the large number of potential predictors of successful aging which were examined, only age, four measures of health status, two measures of mental status, and not having one's spouse die or enter a nursing home were shown to be predictive of successful aging.