New research reveals that middle-aged Americans have worse cardiometabolic health than their British peers, despite Britons engaging in more unhealthy behaviours.
In a recent study published in International Journal of Epidemiologyresearchers investigated differences in health status between United States (US) and British adults. They also explored socioeconomic differences in health between the two nations.
Background
Older people in the United States have poorer health and more health-related socioeconomic inequalities than their British counterparts. Older adults in the US tend to have self-reported hypertension, cardiovascular disease, and diabetes. They also report higher body mass index (BMI) values and an increased prevalence of obesity. However, older British adults tend to engage in unhealthy behaviors such as smoking, drinking alcohol and being sedentary.
However, there is limited research on health differences between the two nations in middle age, when health begins to decline. Previous US-UK comparisons have focused on older people over the age of 50. Assessment of midlife health status could inform policy making and strategy development for healthier ageing.
About the study
In the present study, researchers compared the midlife health of British and American adults, stratified by socioeconomic status.
The study included the National Longitudinal Study of Adolescent to Adult Health (Health Supplement) conducted in the United States with 12,300 people and the British Cohort Study 1970 (BCS70) which included 9,665 people. Participants were aged 33 to 46 years. The team compared smoking status, self-reported health, body mass index (BMI), blood pressure, glycated hemoglobin (HbA1c), and total cholesterol and high-density lipoprotein (HDL) ratio.
The researchers also analyzed the use of medications for specific chronic conditions. They explored variations in health outcomes in early and middle age by socioeconomic status. Parental education, self-education, and annual income determined socioeconomic status.
The researchers assessed socioeconomic differences in mean age during adulthood and childhood socioeconomic status. They also examined associations between childhood socioeconomic status and adult health, adjusting for adulthood socioeconomic status. Poisson regressions determined risk ratios (RR) for analysis. Wald tests showed the statistical significance of socioeconomic differences between the two nations.
Results and discussion
American adults showed higher values for blood pressure (0.30 vs 0.20), cholesterol (0.16 vs 0.10) and BMI (0.40 vs 0.35) than their British counterparts. In contrast, British adults showed higher prevalence rates of poor health (0.18 vs. 0.12) and current smoking (0.28 vs. 0.21) than their American peers. The team found smaller socioeconomic differences in midlife health among British adults than US adults.
For study outcomes such as smoking, adults from the highest socioeconomic class in the US fared better than their counterparts in England. For outcomes such as cholesterol and hypertension, the most socioeconomically advantaged US adults fared the same or worse than the most socioeconomically deprived group in Britain.
University level education was higher among parents of American participants than British participants (36% vs. 21%). University degree completion rates among participants were comparable (40% vs. 36%). Men tended to have higher cholesterol and blood pressure than women. Socioeconomic differences in midlife health were higher for adulthood socioeconomic status than for childhood socioeconomic status. The predicted probability of current smoking and self-reported poor health was higher for less educated adults with lower income.
In Britain, the prevalence of obesity was similar between middle and low income groups, with the highest income quintile showing a significantly lower level of obesity. In the US, there was a gradation of income across the distribution (lowest: 0.5, middle: 0.4, highest: 0.2). The findings revealed that the health disadvantages of middle age in the United States are similar to those reported at older ages.
Health inequality in the United States results from a variety of individual-level causes (eg, physical activity, food, and lifestyle behaviors) and broader social determinants of health. The interplay of these processes remains an important topic for future investigation.
conclusions
The study’s findings, in line with previous research, showed that US adults have poorer cardiometabolic profiles than their English peers, even in early middle age. In contrast, British adults tend to practice unhealthy habits. However, socioeconomic disparities in cardiometabolic health status and health behaviors are higher in the US.
More socioeconomically advantaged individuals in the United States often have comparable or worse self-reported health than British adults from the most disadvantaged socioeconomic group in Britain.
The study’s findings have important implications for practice and policy, as they suggest that socio-political inequalities between nations may lead to differences in health profiles. Smaller inequalities in socio-economic position and better health among Britons may reflect variations in access to health care services and welfare provision.
England has the National Health Service, which is widely accessible and free at the point of use. Health care is mostly private in the US, and costs are often expensive, regardless of availability.
