Americans less healthy than English
Newswise — 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.”
(JAMA. 2006; 295: 2037 – 2045. Available pre-embargo to the media at
http://www.jamamedia.org.)