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UK healthier than US

23rd May 2006

23052006_usahealth1.jpgA study, published in JAMA, shows that people aged 55 to 64 in England are healthier than their counter-parts in the United States. This is despite the higher US spending per person on medical care each year.

The study found that the disparity between the health of middle aged white English and American people is so great 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.

Michael Marmot and colleagues at University College London, the study authors, found that middle aged white English people had lower rates of hypertension, heart disease, heart attacks, strokes, diabetes, lung disease, and cancer than middle aged white Americans.

For the US data the study used information from the US health and retirement survey, which included self reported information, and the national health and nutrition examination survey, which included results of physical and laboratory examinations. For England the study used the English longitudinal study of ageing, which included data from three separate years of the health survey for England, and biological results from the 2003 health survey for England. All four surveys included data on age, sex, household income, and education.

The study says that in both countries, people of higher socioeconomic status were healthier than those lower down the social scale.

Americans report higher levels of disease than the English, and in most cases much higher levels. The study shows that differences in prevalence rates between the two countries for all diseases were all significant.

Cancer mortality was higher in the UK. 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.

Obesity was much more common in the United States. Heavy drinking was more common in England. In both countries about 20% of people in the study smoked.

Given that members of all socioeconomic groups in England had free access to health care, the authors considered whether lifetime access to health care could account for the differences; 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. The authors did not think this gave a full explanation; 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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