Older Americans are not as healthy as older Europeans, study says

Among adults aged 50 to 74, Americans are less healthy than western Europeans, including the English, at almost all wealth levels, and only the richest Americans have the same level of health as their English and other European counterparts. These are some of the findings of a study published in the American Journal of Public Health (2009;99:540-8, doi:10.2105/AJPH.2008.139469) by authors from the Erasmus Medical Center in Rotterdam, the Netherlands; Harvard School of Public Health in Boston, Massachusetts; and University College London. They found no difference by sex.

“Americans face a health disadvantage such that no matter what their wealth, their health lags behind that achieved by comparable Europeans. The disadvantage is remarkably pervasive and affects even the wealthy, but is largest for the poor,” the study says.

The study looked at data from three similar surveys from 2004: the US Health and Retirement Survey; the Survey of Health, Ageing and Retirement in Europe (covering 10 countries and not including any UK countries); and the English Longitudinal Study of Ageing (ELSA). The authors classified wealth as a household’s total net worth. They categorised participants’ education in three ways: lower secondary or US high school; upper secondary (or more than high school but less than a college graduate in the US), and college graduate or higher.

Participants in the study were asked for self reported doctors’ diagnoses of heart disease, stroke, hypertension, diabetes, or high blood sugar; cancer (except skin cancer); lung disease; and disability (measured in terms of limitations in activities of daily living and in mobility and fine motor control).

More than half of participants reported at least one chronic disease, and the prevalence of each health condition was higher in the US than in either England or Europe. About 18% of US respondents reported heart disease, compared with 12% in England and 11% in Europe. About 11% of US adults reported having cancer, compared with 6% in England and 5% in Europe. Limitations on mobility were reported by 59% of US adults, compared with 50% in England and 43% in Europe.

The US health disadvantage was “most substantial in the lowest tertile,” the study says. “After we adjusted for demographics, 22% of adults in the bottom wealth tertile reported heart disease, compared with 17% in the bottom tertile in England and 13% in the bottom tertile in Europe,” the authors say.

England and the US were similar in outcomes between the top and bottom tertiles. “Except for cancer, the prevalence of chronic diseases and functional limitations increased with decreasing wealth tertiles in all countries,” the study says.

Health differences by wealth in Europe tended to be smaller in southern and Mediterranean countries and larger in Scandinavian countries.

Lower disease prevalence in Europe combined with higher survival rates in the US might partly explain their results, the authors say. They note that the US health system focuses more on treatment and less on prevention, and most European countries have a stronger orientation to primary care than the US.

Obesity in the US is higher than in Europe, but smoking is more common in Europe. European health policies are “more generous and egalitarian when compared with those in the United States, may improve health outcomes and reduce disparities,” the study says.

“Tackling risk factors such as obesity and improving the financing and delivery of health services particularly among the poor might partly contribute to eliminating health disparities. Yet changes in broader social policies and determinants may also be required,” the authors conclude.