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Middle-age Americans sicker than UK counterparts
Last Updated: 2006-05-02 15:08:32 -0400 (Reuters Health)
By Karla Gale
NEW YORK (Reuters Health) - Despite greater health care expenditures in the United States, middle-age Americans have a higher prevalence of diseases than residents of the United Kingdom, according to a report in the Journal of the American Medical Association.
"There have been surprisingly few attempts to compare the likelihood of illness between the US and England, and almost no attempt to look at a comparison of the social gradient in health between the two countries," co-author Dr. Michael Marmot told Reuters Health. The mortality rate among adults has been reported to be higher in the United States than in England, and now the rate of illness appears to be higher as well.
Marmot, from University College London, and his team analyzed US data for 4,386 subjects from the Health and Retirement Survey for 2002, and 2,097 from the National Health and Nutrition Examination Survey (NHANES) for 1999-2002.
For the UK, they used data from 3,681 participants in the 2002 English Longitudinal Survey of Aging and 5,526 from the Health Survey for England for 2003. The analysis was limited to non-Hispanic whites
Smoking behaviors were similar in the two countries, but England had more heavy drinkers and the US had higher rates of obesity.
US residents had significantly higher rates of seven conditions -- diabetes, hypertension, any type of heart disease, heart attack, stroke, lung disease and cancer -- even after factoring in age, smoking status, weight and heavy drinking. This suggests that health behaviors do not fully explain the differences between countries.
For example, US residents had a 12.5 percent rate of diabetes versus 7.2 percent for the English. Rates for all heart disease were 15.1 percent and 10.1 percent, respectively, while those for cancer were 9.5 percent and 5.4 percent. The investigators also detected pronounced disparities by education level and income.
Because the information was based on self-reports, the authors checked the accuracy by examining biological markers of disease risk, such as blood sugar levels, blood pressure and cholesterol. Again, the same pattern of higher rates of ill health among US residents emerged, although the difference in high blood pressure was not statistically significant.
"The US spends approximately twice as much per capita on health care as the UK," Marmot noted. Although there is concern that many Americans do not have access to health care because they have no insurance or they are under-insured, "this is unlikely to apply to people of high education or high income."
"Yet our study shows that it is not only the lowest socioeconomic groups where Americans have worse health than in England, but at each point along the socioeconomic spectrum," he continued. "So health care cannot be the main explanation of the higher rate of illness in the US. It is much more likely to be related to social and economic factors."
SOURCE: Journal of the American Medical Association, May 3, 2006.
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