UAB Synopsis, Vol. 25, No. 15, July 3, 2006

While the United States spends considerably more money on medical care per capita ($5,274) each year than England ($2,164), middle-aged to older US residents have higher rates of diabetes, hypertension, heart disease, heart attack, stroke, lung disease, and cancer than their English counterparts, according to a recent Journal of American Medical Association article (2006;295:2037–2045).

James Banks, PhD, University College London and Institute for Fiscal Studies, and colleagues compared data from the US and England to assess the relative health of older individuals and how health varies by socioeconomic status. Researchers used data from the US 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.

The study was limited to non-Hispanic whites in both countries.

The researchers found that white US citizens in late middle age are much less healthy than their English counterparts with a higher incidence of diabetes, hypertension, heart disease, heart attack, stroke, lung disease, and cancer. Diabetes prevalence was twice as high in the US (12.5%) than in England (6.1%), and hypertension was approximately 10% more common. Smoking rates were similar in both countries, with about 1 in 5 people between ages 55 and 64 years currently smoking. Obesity rates were much higher in the US, and heavy drinking was more common in England.

In both countries, disease prevalence was higher among individuals of lower income and education.

US citizens in the top education and income level, however, had similar rates of diabetes and heart disease as English citizens in the bottom education and income level.

The authors write, “… universal health insurance cannot be the central reason for the better health outcomes in England because the top socioeconomic status (SES) tier of the US population have close to universal access but their health outcomes are often worse than those of their English counterparts.

“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. … Second, the SES-health gradient is not a reporting mirage.”

The authors suggest possible areas for further study, such as different experiences with childhood disease and the effect of English social programs, which protect the sick from loss of income and poverty. But no one has the answers yet as to why Americans are sicker and less healthy than European and English counterparts.