Health Inequality in England vs the US

Dawn O'Shea

July 16, 2020

The health equality gap for adults in England is significantly better that that of their peers in the US, according to a paper published in  JAMA Internal Medicine.

In this cross-sectional study including 18,572 persons (46,887 person-years of observations), the health gap between the bottom 20% and top 20% of income distribution was significantly greater for US adults aged 55-64 years than their English peers on 13 of 16 health measures.

The adjusted US-England difference in the prevalence gap between the bottom and top 20% ranged from 3.6 (95% CI, 2.0-5.2) percentage points in stroke to 9.7 (95% CI, 5.4-13.9) percentage points for functional limitation.

Among individuals in the lowest income group in each country, those in the US group vs the England group had significantly worse outcomes on many health measures (10 of 16 outcomes in the bottom income decile).

The significant differences in adjusted prevalence of health problems in the US vs England for the bottom income decile ranged from 7.6% (95% CI, 6.0%-9.3%) vs 3.8% (95% CI, 2.6%-4.9%) for stroke to 75.7% (95% CI, 72.7%-78.8%) vs 59.5% (95% CI, 56.3%-62.7%) for functional limitation.

Among individuals in the highest income group, those in the US vs England had worse outcomes on fewer health measures (4 of 16 outcomes in the top income decile).

The significant differences in adjusted prevalence of health problems in the US vs England for the top income decile ranged from 36.9% (95% CI, 33.4%-40.4%) vs 30.0% (95% CI, 27.2%-32.7%) for hypertension to 35.4% (95% CI, 32.0%-38.7%) vs 22.5% (95% CI, 19.9%-25.1%) for arthritis.

The results suggest the health gap between adults with low vs high income is larger in the US than in England, and the differences in health disadvantages in the US compared with England are more pronounced among individuals with low income.

Choi H, Steptoe A, Heisler M, Clarke P, Schoeni RF, Jivraj S, Cho TC, Langa KM. Comparison of Health Outcomes Among High- and Low-Income Adults Aged 55 to 64 Years in the US vs England. JAMA Intern Med. 2020 Jul 13 [Epub ahead of print]. doi: 10.1001/jamainternmed.2020.2802. PMID: 32658276.  Abstract.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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