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Senior Health & Medicine
Older Americans Are Sicker than Those in England
Study also concludes
income, education make a difference
May 2, 2006 After studying older people in the
U.S. and England, researchers conclude, "Americans are much sicker than
the English." 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 the
article in the May 3 issue of JAMA.
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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 countrys 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 (4,386 residents) and the English Longitudinal Study
of Aging (3,681 residents) to compare self-reported health, income and
education. Those in these groups were aged 55 to 64 years.
To determine whether the tendency to report illness
explained health differences, the researchers also used data from the
National Health and Nutrition Examination Survey (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. Those in these groups were aged 40 to 70.
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.
In both countries, rates of obesity decline with income and with
education.
Heavy drinking was more common in England.
Cancer screening rates are much higher in
the U.S., which the authors says may play a role in the higher rates of
cancer in the U.S.
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"Sir Michael Marmot, the professor who is a co-author of the
report from University College London, said the research showed
that the differences in health could not be ascribed to the
'usual suspects' such as smoking, obesity or alcohol abuse.
Indeed, he said, neither could the disparate nature of health
care systems in the United States and Britain be blamed for the
difference in levels of health.
"'I'm arguing that it's due
to the differences in the circumstances in which people live,'
Sir Michael said in a telephone interview. 'Work, job
insecurity, the nature of communities, residential communities,
et cetera I think that's the place we should try to look.'
Article by Alan Cowell in the New York Times (click
to story) |
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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.
Health disparities between the United States and
England are not solely due to special health problems in the Latino and
especially the black communities in the United States since those
important subpopulations were excluded from this analysis, according to
the authors.
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," they say in conclusion.
"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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