At all levels of socioeconomic status, Americans are much less healthy than their British counterparts, reported James Banks, Ph.D., of University College, London, and his associates.
In both countries, people with the highest levels of education and income are the healthiest, while those of low education and income are the unhealthiest. But the overall differences in health status between the two countries is so profound that the wealthiest Americans have comparable rates of diabetes and heart disease to people at the lowest levels of education and income in England.
Dr. Banks and his associates compared rates of seven major diagnoses among populations of comparable socioeconomic positions in nationally representative samples from the United States and England. To minimize the effects of racial and age differences between the populations, they restricted their study to only non-Hispanic white men and women aged 55–64 years.
The analysis included health-related data on 2,097 Americans and 5,526 British subjects. All were interviewed in 2002 and underwent physical examinations that included laboratory tests to verify their self-report of conditions such as diabetes.
Overall, Americans were more likely to have diabetes, hypertension, heart disease, a history of myocardial infarction or stroke, lung disease, and cancer than British subjects.
Diabetes prevalence was twice as high in the United States (13%) as it was in England (6%), the rate of hypertension was nearly 9% higher, and the rate of heart disease was almost 6% higher, the investigators said (JAMA 2006;295:2037–45).
Regarding markers of future cardiovascular risk, 40% of Americans had high levels of C-reactive protein and 24% had high levels of fibrinogen, compared with 30% and 10%, respectively, among the British participants. Similarly, only 28% of Americans had heart-healthy levels of HDL cholesterol, compared with 44% of the European comparison group. The study was not designed to explain the reasons underlying the large discrepancy in health status between England and the United States, and the investigators did not offer any potential explanations. However, they were able to rule out possible causes.
The discrepancy was not because of differences between the two populations in major risk factors. Smoking status was remarkably similar between the two countries. And although obesity was much more common in Americans, while heavy drinking was much more common in England, “very little of the overall between-country differences in health conditions are due to differences in … behavioral risk factors,” the researchers noted.
Nor did differences in access to health care account for the wide gap in health status. The British participants may have nationalized health care, but most of the Americans in the survey had full insurance coverage. “Health insurance cannot be the central reason for the better health outcomes in England because the top [socioeconomic] tier of the U.S. population have close to universal access but their health outcomes are often worse than those of their English counterparts,” Dr. Banks and his associates said.
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