The populations of the United States and England are very similar in terms of age distribution but differ in terms of other risk factors for poor health (). Within specific age groups, cross-country differences in mean age were never greater than 1 year and were never statistically significant (not shown). The United States has a higher percentage of racial and ethnic minorities, a lower percentage of cigarette smokers, and a lower percentage of heavy alcohol drinkers. Given that respondents tend to underreport substance use in surveys and reporting could vary by country, the rates of smoking and heavy drinking should be interpreted with caution.
Sample Characteristics for the United States (1999–2006) and England (2003–2006)a
Overall, the United States has higher rates of chronic conditions and markers of disease than England (). Differences between the 2 countries are statistically significant for every condition except hypertension. The results were not sensitive to alternative definitions of hypertension and are consistent with previous findings of lower rates of hypertension in the United States than in England (25
). The results were also insensitive to alternative cholesterol and diabetes measures. The disease prevalence for the self-reported conditions is largely consistent with country reports and previous studies (2
Prevalence of Specific Health Conditions in the United States (1999–2006) and England (2003–2006) Presented as Weighted Percentages
Our comparisons by age group indicate that most cross-country differences in health conditions and markers of disease at young ages are as large as those at older ages (). This is the case for obesity, low HDL cholesterol, high cholesterol ratio, high C-reactive protein, hypertension (for females), diabetes, asthma, heart attack or angina (for females), and stroke (for females). For males, heart attack or angina is higher in the United States only at younger ages, and hypertension is higher in England than in the United States at young ages. We indicate next to the age-range labels when cross-country differences are significant at the P < 0.05 level. In no case for which the United States compares unfavorably with England is there a clear age gradient in prevalence risk.
Prevalence of Specific Health Indicators and Risk Factors by Age Group in the United States (1999–2006) and England (2003–2006) Presented as Weighted Percentages and 95% Confidence Intervals, by Gendera
In supplementary analyses (available upon request), we restricted the sample to 1) whites only; 2) individuals who had health insurance; 3) individuals who reported that they drank alcohol less than 5 days per week and who did not currently smoke cigarettes (for adults) or that they were not exposed to household smoke (for individuals under 18 years); 4) individuals who were not obese; and 5) specific income tertiles. For all subsamples, health measures, and age groups, the cross-country differences were consistent with those shown in .
We conducted supplementary analyses that adjusted for body mass index and found that, although differences between the United States and England diminished slightly for certain conditions for certain age and gender groups, overall the significant health differentials between the United States and England were not attenuated (available upon request).
In analyses stratified by body mass index category (normal weight, overweight, and obese) with adjustment for both body mass index and age within each category, we observed no overall pattern of reduction in country differences ( and ). Additional analyses that stratified by both body mass index category and age, with adjustment for body mass index, also revealed no reduction in country differences (available upon request). These findings suggest that cross-country differences in weight distributions are not the driving force behind the observed health differences between the United States and England.
Prevalence of Health Conditions in the United States (1999–2006) and England (2003–2006) for Full and Body Mass Index Subsamples,a Presented as Weighted Percentagesb for Females
Prevalence of Health Conditions in the United States (1999–2006) and England (2003–2006) for Full and Body Mass Index Subsamples,a Presented as Weighted Percentagesb for Males