Health Disadvantage in US Adults Aged 50 to 74 Years: A Comparison of the Health of Rich and Poor Americans With That of Europeans

Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
American Journal of Public Health (Impact Factor: 4.55). 02/2009; 99(3):540-8. DOI: 10.2105/AJPH.2008.139469
Source: PubMed


We compared the health of older US, English, and other European adults, stratified by wealth.
Representative samples of adults aged 50 to 74 years were interviewed in 2004 in 10 European countries (n = 17,481), England (n = 6527), and the United States (n = 9940). We calculated prevalence rates of 6 chronic diseases and functional limitations.
American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12% of English and 11% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95% CI = 1.73, 2.62) in England, and 1.38 (95% CI = 1.23, 1.56) in Europe. Smoking, obesity, physical activity levels, and alcohol consumption explained a fraction of health variations.
American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans.

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Available from: Johan Mackenbach, Feb 26, 2014
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    • "These experiences lead to the current high rates of racial and ethnic health disparities within the United States. 3 Although poor health follows a social gradient, deteriorating U.S. health cannot be fully explained by the health disparities that exist among people who are uninsured or poor; in fact, even the health of relatively elite Americans—those who are White, insured, and college educated, as well as those with high income—is worse than that of their peers in other industrialized countries (Avendano, Glymour, Banks, & Mackenbach, 2009;Institute of Medicine, 2013). Despite these downward trends, health research in the United States lags behind international research efforts to focus on upstream social and economic determinants of health. "
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    • "Additionally, greater egalitarianism does not raise the population's health levels but does weaken the wealthehealth gradient (Semyonov et al., 2013). Another study by Avendano et al. (2009) shows that health tends to increase with wealth among populations over the age 50 in the United States and Europe. Although their analysis focuses on the wealthehealth gradient, it does not classify countries by healthcare system types, and treats 10 European countries uniformly, disregarding possible country-specific effects. "
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    • "These studies focused mainly on media use, but some mentioned other channels, such as health care and informal networks. Replicating such studies among different ethnic groups within European countries seems worthwhile, as health care systems and migration histories of ethnic groups living in these countries are different from those in the USA (Starfield and Shi 2002; Avendano et al. 2009; Kumanyika et al. 2012). Therefore, to gain more insights into the need for channel segmentation, we investigated similarities and differences in the use and perception of communication channels within three ethnic minority groups living in Amsterdam, the Netherlands. "
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