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Cited by 807Health disparities and outcomesHealthcare Policy and ManagementHealth and Medical Studies

Disease and disadvantage in the United States and in England

Banks, James, Marmot, Michael, Oldfield, Zoe, Smith, James P.·2006·JAMA
DOI 10.1001/jama.295.17.2037
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Abstract

CONTEXT: The United States spends considerably more money on health care than the United Kingdom, but whether that translates to better health outcomes is unknown. OBJECTIVE: To assess the relative heath status of older individuals in England and the United States, especially how their health status varies by important indicators of socioeconomic position. DESIGN, SETTING, AND PARTICIPANTS: We analyzed representative samples of residents aged 55 to 64 years from both countries using 2002 data from the US Health and Retirement Survey (n = 4386) and the English Longitudinal Study of Aging (n = 3681), which were designed to have directly comparable measures of health, income, and education. This analysis is supplemented by samples of those aged 40 to 70 years from the 1999-2002 waves of National Health and Nutrition Examination Survey (n = 2097) and the 2003 wave of the Health Survey for England (n = 5526). These surveys contain extensive and comparable biological disease markers on respondents, which are used to determine whether differential propensities to report illness can explain these health differences. To ensure that health differences are not solely due to health issues in the black or Latino populations in the United States, the analysis is limited to non-Hispanic whites in both countries. MAIN OUTCOME MEASURE: Self-reported prevalence rates of several chronic diseases related to diabetes and heart disease, adjusted for age and health behavior risk factors, were compared between the 2 countries and across education and income classes within each country. RESULTS: The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. These differences between countries or across SES groups within each country are not due to biases in self-reported disease because biological markers of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence is twice as high in the United States and only one fifth of this difference can be explained by a common set of risk factors. Similarly, among middle-aged adults, mean levels of C-reactive protein are 20% higher in the United States compared with England and mean high-density lipoprotein cholesterol levels are 14% lower. These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well. CONCLUSION: Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution.

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  • Other factors such as obesity, high blood pressure and alcohol consumption are widely used in the literature as health outcome measures.

    “Thirdly, other factors such as obesity, high blood pressure and alcohol consumption are widely used in the literature as health outcome measures (Banks et al., 2006).”

    From The relationship between physical and mental health: A mediation analysis (2017) · cites this paper as Banks et al., 2006

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Authors
Banks, J., Marmot, M., Oldfield, Z., & Smith, J. P.
Affiliations
  • Institute for Fiscal Studies (GB)
  • University College London (GB)
Corresponding author
Marmot, Michael
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2006-05-03
Volume
295
Issue
17
Pages
2037
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.295.17.2037
OpenAlex
W2147083737
Cited by
807
References
23
Citations by year
2026: 14 · 2025: 13 · 2024: 13 · 2023: 15 · 2022: 15 · 2021: 40 · 2020: 33 · 2019: 41 · 2018: 19 · 2017: 44 · 2016: 42 · 2015: 31 · 2014: 36 · 2013: 50 · 2012: 53
FWCI
76.53
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
  • Economic and Social Research Council (RES-544-28-5001)
  • National Institute on Aging (R01AG040165, P01AG008291, 2R01AG7644-01A1, R37AG012394, R01AG017644, U01AG009740)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Health Professions › General Health Professions › Health and Medical Studies
Keywords
health disparities, social gradient, chronic disease prevalence, diabetes mellitus, heart disease, hypertension, stroke, lung disease, cancer, middle-aged adults, older adults, self-reported illness, C-reactive protein, health care spending, cross-national comparison, United States, England, behavioral risk factors, non-Hispanic whites
MeSH terms
Aged, United Kingdom, Health Status, Health Surveys, Humans, Middle Aged, Morbidity, Risk Factors, Socioeconomic Factors, United States, Vulnerable Populations

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