[Pophealth] dying and being sicker in the USA than England
sabez at u.washington.edu
Tue May 2 21:12:51 PDT 2006
Because you were born in the USA! That is all it takes, whether richer or
poorer, according to this research to be published tomorrow. They use a
variety of methods to make their point that are consistent with our
concepts. A MSNBC commentary follows after the abstract, and those in the
class might inform Robert Blendon why. Stephen
Banks, J., M. Marmot, et al. (2006). "Disease and Disadvantage in the United
States and in England." JAMA 295(17): 2037-2045.
Context The United States spends considerably more money on health care than
the United Kingdom, but whether that translates to better health outcomes is
unknown. Objective To assess the relative heath status of older individuals in
England and the United States, especially how their health status varies by
important indicators of socioeconomic position. Design, Setting, and
Participants We analyzed representative samples of residents aged 55 to 64
years from both countries using 2002 data from the US Health and Retirement
Survey (n = 4386) and the English Longitudinal Study of Aging (n = 3681), which
were designed to have directly comparable measures of health, income, and
education. This analysis is supplemented by samples of those aged 40 to 70
years from the 1999-2002 waves of National Health and Nutrition Examination
Survey (n = 2097) and the 2003 wave of the Health Survey for England (n =
5526). These surveys contain extensive and comparable biological disease
markers on respondents, which are used to determine whether differential
propensities to report illness can explain these health differences. To ensure
that health differences are not solely due to health issues in the black or
Latino populations in the United States, the analysis is limited to
non-Hispanic whites in both countries. Main Outcome Measure Self-reported
prevalence rates of several chronic diseases related to diabetes and heart
disease, adjusted for age and health behavior risk factors, were compared
between the 2 countries and across education and income classes within each
country. Results The US population in late middle age is less healthy than the
equivalent British population for diabetes, hypertension, heart disease,
myocardial infarction, stroke, lung disease, and cancer. Within each country,
there exists a pronounced negative socioeconomic status (SES) gradient with
self-reported disease so that health disparities are largest at the bottom of
the education or income variants of the SES hierarchy. This conclusion is
generally robust to control for a standard set of behavioral risk factors,
including smoking, overweight, obesity, and alcohol drinking, which explain
very little of these health differences. These differences between countries or
across SES groups within each country are not due to biases in self-reported
disease because biological markers of disease exhibit exactly the same
patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence
is twice as high in the United States and only one fifth of this difference can
be explained by a common set of risk factors. Similarly, among middle-aged
adults, mean levels of C-reactive protein are 20% higher in the United States
compared with England and mean high-density lipoprotein cholesterol levels are
14% lower. These differences are not solely driven by the bottom of the SES
distribution. In many diseases, the top of the SES distribution is less healthy
in the United States as well. Conclusion Based on self-reported illnesses and
biological markers of disease, US residents are much less healthy than their
English counterparts and these differences exist at all points of the SES
Blimey! Americans sicker than the Brits
More in U.S. suffer chronic diseases despite more health care spending
CHICAGO - Middle-aged, white Americans are much sicker than their counterparts in England, startling new research shows, despite U.S. health care spending per person that's more than double what Britain spends.
A higher rate of Americans tested positive for diabetes and heart disease than the British. Americans also self-reported more diabetes, heart attacks, strokes, lung disease and cancer.
The gap between the countries holds true for educated and uneducated, rich and poor.
Story continues below Å´ advertisement
“At every point in the social hierarchy there is more illness in the United States than in England and the differences are really dramatic," said study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.
The study, appearing in Wednesday's Journal of the American Medical Association, adds context to the already-known fact that the United States spends more on health care than any other industrialized nation, yet trails in rankings of life expectancy.
The United States spends about $5,200 per person on health care while England spends about half that in adjusted dollars.
“Everybody should be discussing it: Why isn't the richest country in the world the healthiest country in the world?" Marmot said.
“It's something of a mystery," said Richard Suzman of the U.S. National Institutes of Health, which helped fund the study.
The researchers looked for answers in the data, which came from government-sponsored health surveys. The research was supported by grants from government agencies in both countries. A U.S. researcher from the Rand Corp. was on the team.
Americans more obese
Smoking rates are about the same on both sides of the pond. Brits have a higher rate of heavy drinking, but a higher percentage of Americans are obese.
The researchers crunched numbers to create a hypothetical statistical world in which the British had American lifestyle risk factors, including being as fat as Americans. In that model, the researchers found Americans still would be sicker.
Only non-Hispanic whites were included in the study to eliminate the influence of racial disparities. The researchers looked only at people ages 55 through 64, and the average age of the samples was the same.
Americans reported twice the rate of diabetes compared to the British: 12.5 percent versus 6 percent. For high blood pressure, it was 42 percent for Americans versus 34 percent for the British; cancer showed up in 9.5 percent of Americans compared to 5.5 percent of Britains.
The upper crust in both countries was healthier than middle-class and low-income people in the same country. But richer Americans' health status resembled the health of the low-income British.
Health experts have known the U.S. population is less healthy than that of other industrialized nations, according to several important measurements. U.S. life expectancy, for example, ranks behind that of about two dozen other countries, according to the World Health Organization.
Some have believed the U.S. has lagged because it has a more ethnically diverse population than some of the higher-ranking countries, said Suzman, who heads the National Institute on Aging's Behavioral and Social Research Program. “Minority health in general is worse than white health," he said.
But the new study showed that when minorities are removed from the equation, and adjustments are made to control for education and income, white people in England are still healthier than white people in the United States.
“As far as I know, this is the first study showing this," said Suzman who called the results “surprising." But some other experts said the findings were predictable.
No financial safety net
Earlier studies have shown the United States does a poorer job than other industrialized countries at providing primary medical care to its citizens, particularly to those with less education and income, said Dr. Barbara Starfield, a professor of health policy and pediatrics at Johns Hopkins University.
“Countries oriented toward providing good primary care basically do better in health," she said.
Marmot offered yet another explanation for the gap: Americans' financial insecurity. Improvements in household income have eluded all but the top fifth of Americans since the mid-1970s. Meanwhile, the British saw their incomes improve, he said.
Robert Blendon, a professor of health policy at the Harvard School of Public Health who was not involved in the study, said the stress of striving for the American dream may account for Americans' lousy health.
“The opportunity to go both up and down the socioeconomic scale in America may create stress," Blendon said. Americans don't have a reliable government safety net like the English enjoy, Blendon said.
However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed.
Both said it might explain better health for low-income citizens, but can't account for better health of Britain's more affluent residents.
Marmot cautioned against looking for explanations in the two countries' health-care systems.
“It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said.
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