People aged 55 to 64 in England are healthier than their counter-parts in the United States, a new study shows. This is despite the fact that the US spends $5274 (£2900; €4193) per person on medical care each year and the United Kingdom as a whole spends only $2164.
The disparity between the health of middle aged white English and American people found is so great, the study found, that the prevalence of diabetes and heart disease among Americans of the highest socioeconomic status is similar to that among the lowest status English people.
The study's authors, Michael Marmot and colleagues at University College London, found that middle aged white English people had lower rates of diabetes, hypertension, heart disease, heart attacks, strokes, lung disease, and cancer than middle aged white Americans (JAMA2006;295: 2037-45 [PubMed] [Google Scholar]). The reason remains a puzzle, although the study suggests some possible reasons.
For the US data the study used information from the US health and retirement survey (4386 people), which included self reported information, and the national health and nutrition examination survey (2097 people), which included results of physical and laboratory examinations. For England the study used the English longitudinal study of ageing (3681 people), which included data from three separate years of the health survey for England (5526 people), and biological results from the 2003 health survey for England.
All four surveys included data on age, sex, household income, and education.
In both countries, people of higher socioeconomic status were healthier than those lower down the social scale, the study says.
“Americans report higher levels of disease than the English, and in most cases much higher levels,” the study reports. Differences in prevalence rates between the two countries for all diseases were all significant.
Higher rates of cancer in the US may be explained by higher rates of screening, but this does not completely explain the higher prevalence in the US. Cancer mortality was higher in the UK.
In both countries about 20% of people in the study smoked.
Heavy drinking was more common in England. Obesity was much more common in the United States.
The authors considered whether lifetime access to health care could account for the differences, given that members of all socioeconomic groups in England had free access to health care. In the US people aged over 65 have health insurance in the form of the Medicare programme, but they may not have had insurance earlier in their lives. But the authors did not think this gave a full explanation, because although Americans in the highest socioeconomic status group almost always had health care their health outcomes were often worse than those of their English counterparts.
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