Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans

Abstract

Objectives: We compared the health of older US, English, and other European adults, stratified by wealth.

Methods: 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.

Results: 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.

Conclusions: American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans.

FIGURE 1

Prevalence of chronic disease and disability among men and women aged 50 to 74 years in the United States, England, and Europe: HRS, United States, 2004; ELSA, England, 2004; and SHARE, Europe, 2004. Notes. HRS = Health and Retirement Survey; ELSA = English Longitudinal Study of Ageing; SHARE = Survey of Health, Ageing and Retirement in Europe; IADL = instrumental activities of daily living. Model adjusted for age and gender; lines indicate 95% confidence intervals.

FIGURE 2

LOESS function of chronic disease and disability by wealth among men and women aged 50 to 74 years in the United States, England, and Europe, for (a) heart disease, (b) stroke, (c) hypertension, (d) diabetes, (e) cancer, (f) lung disease, (g) 1 or more IADL limitation, and (h) 1 or more mobility limitation: HRS, United States, 2004; ELSA, England, 2004; and SHARE, Europe, 2004. Notes. HRS = US Health and Retirement Survey; ELSA = English Longitudinal Study of Ageing; SHARE = Survey of Health, Ageing and Retirement in Europe; IADL = instrumental activities of daily living. Models adjusted for age, gender, and educational level. Wealth values are in euros (€ 1.00 = US $1.24) and were adjusted by purchasing power parity.