Posted May 3, 2006
While the United States spends considerably more money on medical care per capita ($5,274) each year than England ($2,164), middle-aged to older US 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 the Journal of the American Medical Association. (2006;295:2037–2045).
James Banks, PhD, University College London and Institute for Fiscal Studies, and colleagues compared data from the US and England to assess relative health of older individuals and how health varies by socioeconomic status. The researchers used data from the US Health and Retirement Survey (4,386 residents) and the English Longitudinal Study of Aging (3,681 residents) to compare self-reported health, income, and education.
To determine whether the tendency to report illness explained health differences, researchers used National Health and Nutrition Examination Survey data (2,097 residents) and Health Survey for England (5,526 residents) to compare biological markers of disease. The study was limited to non-Hispanic whites in both countries.
The researchers found that white US 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 US (12.5%) than in England (6.1%), and hypertension was approximately 10% more common in the US. Smoking rates were similar in both countries, with about one in five people between ages 55 and 64 years currently smoking. Obesity rates were much higher in the US, 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 were so great that US citizens in the top education and income level had similar rates of diabetes and heart disease as English citizens in the bottom education and income level.
“The authors write. “… universal health insurance cannot be the central reason for the better health outcomes in England because the top socioeconomic status (SES) tier of the US 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 not a reporting mirage… Instead, the SES-health gradient appears with equal force in either self-reports or biological measures of health.”