Health Differences at Older Ages between U.S. and England - Role of Local Contextual Factors

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Project Summary The U.S. spends far more on health care than other high-income countries. Yet, older adults in the U.S. are sicker and have shorter lives compared to older adults in many other high-income countries and even some middle-income countries. Reasons for the U.S. health disadvantage are not well understood. Substantial health gap between the U.S. older adults and their high income peers persists even after controlling for individual-level factors such as education and behavioral risks. Older adults are more likely to rely on the physical and social environment in their local areas. At the same time, local area-level contextual characteristics vary substantially across countries which might have contributed to differences in health/mortality across countries. However, local amenities and resources have not been examined systematically in efforts to understand difference in older adults' health status across countries. This project will assess whether and, if so, the extent to which local, contextual characteristics explain the poorer health status of older adults in the U.S. compared to England. Using the Health and Retirement Study (HRS) and English Longitudinal Study of Aging (ELSA), - Based on a newly available contextual dataset that is linked to the HRS, we will create a comparable contextual dataset to be linked to the ELSA at each geographic boundary. We will use comparable, local geographic areas between HRS and ELSA by examining county and census track for the U.S. and local authority and middle layer super output area for England. - We will assess the extent to which local contextual measures explain key health and mortality differences between the U.S. and the England. Health outcomes include both comprehensive self-reported health measures, measured physical performances (e.g., gait speed) and cognitive functioning, and biomarkers (e.g., HbA1c) that are comparable between HRS and ELSA. - We will assess differences in income and wealth gradient in health/mortality between the U.S. and England, and assess the extent to which local contextual factors influence the difference. The proposed exploratory and developmental project will contribute to advancing literature in the new directions by providing new insights into potential mechanism whereby local contextual characteristics influence the international health gap. Outcomes from this project will include: contextual datasets linked to the HRS and ELSA; findings on the potential role of local-area environment for the international health gap; and an international research collaboration that will substantially benefit our future study and may ultimately expand research on health differences at older ages beyond HRS and ELSA. 1