Disease and disadvantage in the United States and in England
Disease and disadvantage in the United States and in England
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DOI：
10.1001/jama.295.17.2037
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发表时间：
2006-05-03
影响因子：
120.7
通讯作者：
Smith, JP
中科院分区：
文献类型：
--
作者：
Banks, J;Marmot, M;Smith, JP
背景 美国在医疗保健上的支出比英国多得多，但这是否意味着更好的健康结果尚不清楚。目的 评估英国和美国老年人的相对健康状况，特别是他们的健康状况如何因社会经济地位的重要指标而变化。设计、环境和参与者我们使用 2002 年美国健康和退休调查的数据分析了两国 55 至 64 岁居民的代表性样本 （n= 4386）和英国老龄化纵向研究（n= 3681），其目的是对健康、收入和教育进行直接可比较的衡量。该分析还补充了 1999-2002 年国家健康和营养检查调查 (n= 2097) 和 2003 年英格兰健康调查 (n= 5526) 中 40 至 70 岁人群的样本。这些调查包含受访者的广泛且可比较的生物疾病标记，用于确定报告疾病的不同倾向是否可以解释这些健康差异。为了确保健康差异不仅仅归因于美国黑人或拉丁裔人口的健康问题，该分析仅限于两国的非西班牙裔白人。主要结果指标对两国之间以及每个国家内不同教育和收入阶层的自我报告的几种与糖尿病和心脏病相关的慢性疾病的患病率进行了比较，并根据年龄和健康行为风险因素进行了调整。结果美国中年晚期人口的健康状况低于同等水平 英国人口患有糖尿病、高血压、心脏病、心肌梗塞、中风、肺病和癌症。在每个国家内，都存在明显的负社会经济地位（SES）梯度和自我报告的疾病，因此在SES层次结构的教育或收入变体的底部，健康差异最大。这一结论对于控制一组标准的行为风险因素（包括吸烟、超重、肥胖和饮酒）通常是稳健的，而这些因素几乎无法解释这些健康差异。国家之间或每个国家内部社会经济地位群体之间的这些差异并不是由于自我报告疾病的偏差造成的，因为疾病的生物标志物表现出完全相同的模式。举例来说，在 55 岁至 64 岁的人群中，糖尿病患病率是美国的两倍，而这种差异中只有五分之一可以用一组常见的危险因素来解释。同样，在中年成年人中，美国的 C 反应蛋白平均水平比英国高 20%，而高密度脂蛋白胆固醇平均水平则低 14%。这些差异不仅仅由 SES 分布的底部造成。在许多疾病中，美国居民的 SES 分布顶部也不太健康。 结论 根据自我报告的疾病和疾病的生物标记，美国居民的健康状况远低于英国居民，并且这些差异存在于 SES 分布的所有点。
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.