Are Yanks Sicker Than Brits?

Or are we just a bunch of hypochondriacs?

Earlier this month the Journal of the American Medical Association published a study that startlingly concluded that older white Americans were much less healthy than white British people. Yanks are sicker than Brits despite the fact that, on average, Americans spend more than twice as much as the British do for health care. However, the study is not a paean to the joys of government-funded health care. The researchers note "health insurance cannot be the central reason for the better health outcomes in England because the top socioeconomic-status tier of the U.S. population have close to universal access but their health outcomes are often worse than those of their English counterparts."

The study compared American and British cohorts between the ages 55 to 64 and found higher rates of diabetes, hypertension, heart disease, heart attack, stroke, and lung disease and cancer among Americans. They had double the rate of diabetes (12.5 percent vs. 6.1 percent); ten percent more Americans reported high blood pressure; and 31 percent of these older Americans were obese compared to 23 percent of Britons. The study also looked at the results of various routine medical tests and found that Americans had higher levels of glycosylated hemoglobin (a measure for diabetes); lower levels of heart protective good cholesterol; and high levels of heart harming C-reactive protein. Generally the researchers attribute all this bad health to obesity and high pressure competitive American lifestyles. But is it true?

"It's considerably overblown," says health demographer Kenneth Manton of Duke University. A quick look at other studies and datasets reveal a much less alarming picture. Let's start with the most basic health indicator--average life expectancy. Although the JAMA study looked only at the health of white citizens of both countries, I found it difficult to scare up data for just white Britons, so the data here are averages for all citizens in both countries. In the U.S. life expectancy for white females is 80.1 years and for white males it is 74.8 years. In Britain, female life expectancy is 80.5 years and males can expect to live 75.8 years. In other words, there is essentially no difference. But what about life expectancy at age 65? Half of all British women aged 65 will live another 19 years and half of the men will enjoy an 14 additional years. Half of American women aged 65 will make it another 19.8 years and while American men will average 16.9 years. But if older Americans are dramatically less healthy than older Britons, shouldn't they die earlier?

Looking at some specific disease data, one finds again that there is not really much difference between Americans and Britons. Take cardiovascular diseases for instance. In the U.S. 42.3 people out of 100,000 die of a heart attack each year. The figure is 45.3 for Britain. On the other hand, 108.8 per 100,000 Americans die of heart failure compared to 95.3 per 100,000 in the United Kingdom. With regard to strokes, 48.3 per 100,000 Britons die of strokes whereas 33.4 Americans do.

How about cancer? In 1996 (the latest figures I could find) cancer incidence among British males was 437.4 per 100,000 and among females it was 429.9 per 100,000. In 1998 British men died of cancer at a rate of 275.3 per 100,000 and the cancer death for women was 245.9 per 100,000. This compares with a cancer incidence among U.S. men (1993-1997) of 475.5 per 100,000 and among women at 374.8. Interestingly, even in the mid-1990s, deaths from cancer in America were considerably lower than in Britain, male cancer mortality running at 209.7 per 100,000 and female mortality at 139.8 per 100,000.

A 2003 JAMA study found that the blood pressure of go-go Americans was lower than their more complacent European counterparts.

What could be going on? The indispensable science reporter Gina Kolata over at the New York Times makes the point that at least part of the answer is that Americans spend a lot of that extra money on a wide array of medical tests These include PSA tests for prostate cancer; mammograms for breast cancer; 64 slice CT scanners for coronary artery disease; and a regular battery of blood tests to carefully monitor cholesterol and insulin levels. Doctors tell people that they are suffering from metabolic syndrome which until a few years ago would have just meant they should lose some weight.

In the JAMA study about twice as many Americans said that they've had cancer than Britons, but the cancer incidence rates are not all that different. Part of answer to the paradox of sick Americans versus healthy Britons is that by resorting to more testing and more aggressive doctoring we Americans get diagnosed with something more frequently. Kolata ends with a wonderful anecdote in which "a doctor-in-training was asked by his professor to define a well person. The resident thought for a moment. A well person, he said, is 'someone who has not been completely worked up.'" The JAMA study likely reflects the fact that America and Americans have been a lot more "completely worked up" than the British have.