May 2, 2006
Middle-aged Americans are less healthy than their English counterparts, according to a study issued today by researchers from the RAND Corporation, University College London and the Institute for Fiscal Studies in London.
Analyzing surveys of large groups of middle-aged people from the United States and England, researchers found that Americans ages 55 to 64 suffer from diseases such as diabetes, high-blood pressure and lung cancer at rates up to twice those seen among similar aged people in England.
The prevalence of diabetes was twice as high in the United States (12.5 percent) as compared to England (6.1 percent), while high blood pressure was about 10 percentage points higher in the United States than in England. Heart disease was 50 percent more common among middle-aged Americans than the English, while the rates of stroke, lung disease and cancer were higher among Americans as well.
The differences were confirmed when researchers analyzed separate studies that collected blood samples from participants to look for biological markers of disease. This showed that the differences were not just a result of Americans' increased willingness to report illness.
The study appears in the May 3 edition of the Journal of the American Medical Association.
“You don't expect the health of middle-aged people in these two countries to be too different, but we found that the Americans are a lot less healthy than the English,” said James P. Smith, a RAND economist and one of the study's authors. “It's not just a difference in how people characterize their own health. The biological measures confirm there is a difference.”
Reports of poorer health were seen across all economic groups in the United States in comparison to their English peers, not just among the poor who are generally seen as having more health problems.
Except for cancer, people with less income and education in both of the nations were more likely to report being sick than those with more income and education. Because of the differences between the two nations, those at the top of the education and income scale in the United States reported rates of diabetes and heart disease that were similar to those at the bottom of the scale in England.
Researchers were concerned that any differences in health might be blamed on the higher rates of illness seen among Latinos and African-Americans in the United States, so the study included only non-Hispanic Caucasians in both countries.
Researchers say that the differences in health between the two nations is not fully explained by lifestyle factors, including smoking, drinking, excess weight and poor exercise. Smoking behavior is similar in the two nations, while excessive drinking of alcohol is more common in England.
Obesity is more common in the United States and Americans get less exercise, according to the study. But researchers estimate that those factors account for less than half of the differences seen between middle-age people from the United States and England.
Researchers say that past differences in health risk factors may be one explanation for the disparities seen in the middle-aged people covered by the study.
Rising obesity has occurred in the United Kingdom only recently, with the incidence increasing from 7 percent in 1980 to 23 percent in 2003. Meanwhile, the prevalence of obesity in the United States rose from 16 percent to 31 percent during the same period.
“It may be that America's longer history of obesity or differences in childhood experiences create the problems seen among middle-aged Americans,” said study co-author James Banks, an economist at University College London. “This may mean that over time the gap between England and the United States may begin to close.”
The difference in health between middle-age people in the United States and England occurs despite the fact that per person medical spending in the United States is more than twice as high as it is in the United Kingdom.
The two nations also have different health systems, with the United Kingdom providing universal publicly funded health care for all households, while the United States has universal publicly funded health care only for citizens over age 65.
“In the United States and England, there were remarkably similar socioeconomic differences in health: the less education and income people had the worse their health,” said study-co-author Dr. Michael Marmot, an epidemiologist at University College London. “We cannot blame either bad lifestyle or inadequate medical care as the main culprits in these socioeconomic differences in health. We should look for explanation to the circumstances in which people live and work.”
Researchers, who also included Zoe Oldfield of the Institute for Fiscal Studies, conducted the study by analyzing results from several large surveys conducted in each nation from 1999 to 2003. In the United States, surveys used were the Health and Retirement Survey and the National Health and Nutrition Examination Survey. For England, researchers analyzed the English Longitudinal Survey of Aging and the 2003 Health Survey for England.
The research was support by a grant to RAND from the National Institute of Aging and a grant to the Institute for Fiscal Studies from the Economic and Social Research Council of the United Kingdom.
The study was done through the RAND Labor and Population Program, which examines issues involving U.S. labor markets, the demographics of families and children, social welfare policy, the social and economic functioning of the elderly, and economic and social change in developing countries.
Note: Numbers adjusted to take account of differences in drinking, smoking and obesity/overweight