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White middle-aged English are healthier than their American counterparts, and in both countries lower income and education levels are associated with poorer health, according to a new comparison of key American and English health surveys.

Comparing self-reports of chronic diseases such as diabetes and heart disease between the two countries, the researchers found that Americans reported significantly higher levels of disease than the English.

For example, the prevalence of diabetes in the age group was twice as high in Americans as in the English, and the healthiest Americans in the study those in the highest income and education levels had rates of diabetes and heart disease similar to the least healthy in England those in the lowest income and education levels there.

The lowest income and education group in the two countries reported the most cases of diabetes, hypertension, heart disease, heart attacks, strokes and chronic lung disease, while the highest income and education groups reported the least. The only disease for which this inverse relationship was not true was cancer.

The researchers said they found that differences between countries in smoking, obesity and alcohol use explained little of the difference.

The research was supported by the National Institute on Aging (NIA), part of the NIH in the U.S. Department of Health and Human Services, and British government agencies.

James Smith, PhD, of the RAND Corp., Zoe Oldfield, MSc, of the University of London, and Sir Michael Marmot, MD, and James Banks, PhD, both of University College (London), reported the comparison in the May 3 issue of the Journal of the American Medical Association.

Smith and colleagues chose comparable samples of people ages 55 to 64 from two large, national health surveys: 4,386 from the U.S. Health and Retirement Study and 3,681 from the English Longitudinal Study of Aging. Each sample was divided into three groups based on education and income. Both samples were limited to non-Hispanic white populations, allowing the researchers to control for special issues in different racial/ethnic communities in both countries.

"This study challenges the theory that the greater heterogeneity of the U.S. population is the major reason the United States is behind other industrialized nations in some important health measures," said Richard Suzman, director of NIA's Behavioral and Social Research Program. "By focusing on the comparable white populations, this study still finds the U.S. lagging."

"This comparison raises some important questions about the relationship among health, education and income in both countries," said Richard Hodes, MD, director of the NIA. "As many nations try to address the challenges of population aging, it will be critical to know why these differences in health status appear."

Use of other study measurements also confirmed the differences in diabetes and hypertension prevalence between the two countries.

The researchers point out that the differences exist despite greater American healthcare expenditures, similar patterns in life expectancy between the two countries and the fact that smoking behavior in the two countries is similar.

They suggest possible areas for further consideration and study, such as the different experiences in childhood diseases translating to differences in adult disease. They also noted that social programs in Great Britain might help protect those who are sick from loss of income and poverty, and the lack of such programs in the U.S. may explain the greater association between health and wealth for Americans found in studies by Smith and others.

Further, they said that extending the study to other countries with different health systems, such as Canada and the rest of Europe, and looking at minorities would allow experts to compare the effects of publicly funded healthcare in each country.