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Middle-aged English people are healthier than their American counterparts

Publication date: May 3, 2006 9:16:40 AM

Middle-aged English people are healthier than their American counterparts, according to a collaborative study by English and US researchers.

Americans aged between 55 and 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, reports the study, published on Tuesday 2 May in the Journal of the American Medical Association.

By analysing a large representative sample of people from each country, researchers from the Institute for Fiscal Studies, UCL and RAND in the US found that English people were less likely to report suffering from a wide array of diseases. The differences were confirmed when researchers analysed separate studies that collected blood samples from participants to look for biological markers of disease – showing that the differences were not just a result of Americans’ increased willingness to report illness.

Professor James Smith, of RAND and one of the study’s authors, says: “You don’t expect the health of middle-aged people in these two countries to be too different, but we found that the English are a lot healthier than the Americans. “It’s not just a difference in how people characterise their own health. The biological measures confirm there is a difference.”

English people reported better health than their American peers across a range of illnesses. The prevalence of diabetes was nearly twice as high in the US (12.5 per cent) as compared to England (6.1 per cent), while high blood pressure was approximately 10 percentage points higher in the US than in England. Heart disease was 50 per cent higher among middle-aged Americans than the English, while the rates of stroke, lung disease and cancer were higher as well.

Reports of poorer health were seen for all socioeconomic groups in the US in comparison to their English peers, not just among the poor. With the exception of cancer, people with lower incomes and educational achievement in both of the nations were more likely to report being ill than those with higher incomes and educational achievement.  But, because of the differences between the two nations, those at the top of the education and income scale in the US reported rates of diabetes and heart disease that were similar to those at the bottom of the scale in England.

Professor Sir Michael Marmot, of the UCL Department of Epidemiology & Public Health, says: “In the US and England there were remarkably similar socioeconomic differences in health: the less education and income people had, the worse their health. 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.”

The study shows that the differences in health between the two nations are not fully explained by lifestyle factors, such as smoking, drinking, excess weight and poor exercise. Smoking behaviour is similar in the two nations, while excessive drinking of alcohol is more common in England. Obesity is more common in the US, and Americans get less exercise, according to the study. But researchers estimate that those factors together account for less than half of the differences. Nor are the differences accounted for by higher rates of black and Hispanic population in the US, who are groups known to have poorer health, since these are excluded from the study.

Researchers say that past differences in health risk factors may be one explanation for the disparities seen in the subjects covered by the study. Rising obesity has occurred in the UK only recently, with the rate increasing from seven per cent in 1980 to 23 per cent in 2003. Meanwhile, the prevalence of obesity in the US rose from 16 per cent to 31 per cent during the same period.

Professor James Banks, of the UCL Department of Economics and Institute for Fiscal Studies and one of the authors of the study, says: “It may be that England’s shorter history of obesity or differences in childhood experiences create an advantage with respect to middle-aged Americans. But this may mean that over time the gap between England and the United States will begin to close.” 

The difference in health between middle-aged people in England and the US occurs despite the fact that per person medical spending in the US is more than twice as high as it is in the UK. The two nations also have different health systems, with the UK providing publicly funded health care for all households, while the US has publicly funded health care only for citizens over age 65.

The study uses older middle-aged members of several large surveys conducted in each nation from 1999 to 2003.  In England, the data are drawn from the English Longitudinal Study of Ageing (3,681 people aged 55-64) and the Health Survey for England (5,526 people aged 40-70). For the US, the surveys used were the Health and Retirement Survey (4,386 people aged 55-64) and the National Health and Nutrition Examination Survey (2,097 people aged 40-70).

Notes to editors:

1. The authors of the study, ‘Disease and Disadvantage in the USA and in England’ are Professor James Banks, Institute for Fiscal Studies and Department of Economics, University College London; Professor Sir Michael Marmot, International Institute for Society and Health, Department of Epidemiology and Public Health, University College London; Professor James P. Smith, RAND; and Zoë Oldfield, Institute for Fiscal Studies.

2. The research was supported by a grant from the US National Institute of Aging to RAND and the Institute for Fiscal Studies, from the Economic and Social Research Council to IFS and from the MRC to UCL. IFS is an independent institute researching public policy in the UK; RAND corporation is a non-profit research organisation in the US.

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