Americans less healthy than English

May 02, 2006

Middle-aged to older U.S. residents have higher rates of diabetes, hypertension, heart disease, heart attack, stroke, lung disease and cancer than their English counterparts, according to an article in the May 3 issue of JAMA.

The United States spends considerably more money on medical care per capita ($5,274) than the United Kingdom ($2,164). However, whether greater financial expenditures translate into better health for a country's citizens is uncertain. Strong links between socioeconomic position and health exist in both the U.S. and the U.K. Comparing social differences in illness across both countries can give insight into possible causal explanations for the relationship between socioeconomic status and health.

James Banks, Ph.D., of University College London and Institute for Fiscal Studies, London, and colleagues compared data from the U.S. and England to assess the relative health of older individuals and how health varies by socioeconomic status in the two countries. The researchers used data from the U.S. Health and Retirement Survey (HRS; n = 4,386 residents) and the English Longitudinal Study of Aging (n = 3,681 residents) to compare self-reported health, income and education. To determine whether the tendency to report illness explained health differences, the researchers also used data from the National Health and Nutrition Examination Survey (NHANES; n = 2,097 residents) and Health Survey for England (n = 5,526 residents) to compare biological markers of disease. The study was limited to non-Hispanic whites in both countries.

The researchers found that U.S. citizens in late middle age are much less healthy than their English counterparts for diabetes, hypertension, heart disease, heart attack, stroke, lung disease and cancer. Diabetes prevalence was twice as high in the U.S. (12.5 percent) than in England (6.1 percent) and hypertension was approximately 10 percentage points more common in the U.S. Smoking behavior was similar in both countries, with about one in five people between the ages of 55 and 64 years currently smoking. Obesity rates were much higher in the U.S. and heavy drinking was more common in England. In both countries, disease prevalence was much higher among individuals of lower income and education, compared with those at higher income and education levels. Differences in socioeconomic groups between the two countries were so great that those in the top education and income level in the U.S. had similar rates of diabetes and heart disease as those in the bottom education and income level in England.

"Although access to health care is important, differential access can only offer a partial explanation for our findings," the authors write. "... health insurance cannot be the central reason for the better health outcomes in England because the top socioeconomic status (SES) tier of the U.S. population have close to universal access but their health outcomes are often worse than those of their English counterparts."

"Two simple but powerful conclusions follow from our comparisons using biological and self-reports of disease in England and the United States. First, Americans are much sicker than the English. ... Second, the SES-health gradient is also not a reporting mirage... Instead, the SES-health gradient appears with equal force in either self-reports or biological measures of health."
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(JAMA. 2006; 295: 2037 - 2045. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the JAMA article for funding/support information.

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