By Karla Gale

NEW YORK (Reuters Health) May 02 - Despite greater health care expenditures in the US, middle-aged Americans have a higher prevalence of diseases than residents of the UK, according to a report in the Journal of the American Medical Association for May 3.

"There have been surprisingly few attempts to compare the likelihood of illness between the US and England, and almost no attempt to look at a comparison of the social gradient in health between the two countries," co-author Dr. Michael Marmot told Reuters Health. "Data show that mortality rates for adults are higher in the US than in England. Now we show that morbidity rates are higher too."

Dr. Marmot, from University College London, and his team analyzed US data from the Health and Retirement Survey for 2002 and from the National Health and Nutrition Examination Survey (NHANES) for 1999-2002. For the UK, they used data from the 2002 English Longitudinal Survey of Aging and the Health Survey for England for 2003.

They restricted their analyses to non-Hispanic whites. Self-reported illness data included that from subjects ages 55 to 64 years, and data for biological markers included subjects ages 40 to 70 years. The surveys included 2097 to 5526 participants each.

The authors note that smoking behaviors were similar in the two countries, but that England had more heavy drinkers and that rates of obesity were higher in the US.

For all seven conditions - diabetes, hypertension, all heart disease, MI, stroke, lung disease, and cancer -- the US residents reported significantly higher prevalence than did British residents, even after adjusting for age, smoking status, BMI, and heavy drinking, with p < 0.01 for each comparison. This suggests that health behaviors do not fully account for the significant differences between countries.

For example, US residents reported an adjusted diabetes prevalence of 12.5% versus 7.2% for the English. Rates for all heart disease were 15.1% and 10.1%, respectively, while those for cancer were 9.5% and 5.4%.

They also observed pronounced gradients of self-reported disease in both countries, with disparities largest among those with the least education and the lowest incomes.

To check the accuracy of the self-reports, the authors also examined biological markers of disease risk - glycosylated hemoglobin, blood pressure, C-reactive protein, fibrinogen, and HDL cholesterol. Again, the same patterns of more ill health among US residents emerged, although the presence of hypertension was not statistically significant.

"The US spends approximately twice as much per capita on health care as the UK (in purchasing power parities)," Dr. Marmot noted. "Although there is concern that a large proportion of Americans do not have access to this expenditure because of uninsurance or under- insurance, this is unlikely to apply to people of high education or high income. "

"Yet our study shows that it is not only the lowest socio-economic groups where Americans have worse health than in England, but at each point along the socio-economic spectrum," he continued. "So health care cannot be the main explanation of the higher rate of illness in the US. It is much more likely to be related to social and economic factors."

Reuters Health Information 2006. © 2006 Reuters Ltd.
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