New research reveals that middle-aged Americans have poorer cardiometabolic health than their British peers, despite Brits engaging in more unhealthy behaviors.
In a recent study published in the International Journal of Epidemiology, researchers investigated differences in the health status between the United States (US) and British adults. They also explored socioeconomic differences in health among the two nations.
Background
Older individuals in the United States have poorer health and more socioeconomic inequalities related to health than their British counterparts. Older adults in the US tend to have self-reported hypertension, cardiovascular disease, and diabetes. They also report higher body mass index (BMI) values and an increased prevalence of obesity. However, older British adults tend to engage in unhealthy behaviors like smoking, alcohol intake, and sedentary activities.
However, there is limited research on the differences in health among the two nations in middle age, when health begins to deteriorate. Previous US-Britain comparisons have focused on older individuals aged above 50 years. Evaluating midlife health status could inform policymaking and strategy development for healthier aging.
About the study
In the present study, researchers compared the midlife health of British and US adults, stratified by socioeconomic status.
The study included the National Longitudinal Study of Adolescent to Adult Health (Add Health) conducted in the United States with 12,300 individuals and the 1970 British Cohort Study (BCS70) comprising 9,665 individuals. Participants were aged 33 to 46 years. The team compared smoking status, self-reported health, body mass index (BMI), blood pressure, glycated hemoglobin (HbA1c), and the ratio of total cholesterol and high-density lipoprotein (HDL).
Researchers also analyzed medication use for specific chronic conditions. They investigated variations in health outcomes in the early and middle ages by socioeconomic status. Parental education, self-education, and annual income determined the socioeconomic status.
Researchers assessed socioeconomic differences in middle age by adulthood and childhood socioeconomic status. They also examined associations between childhood socioeconomic status and adult health, adjusting for adulthood socioeconomic status. Poisson regressions determined risk ratios (RR) for analysis. Wald tests indicated the statistical significance of socioeconomic differences between the two nations.
Results and discussion
American adults showed higher values for blood pressure (0.30 vs. 0.20), cholesterol (0.16 vs. 0.10), and BMI (0.40 vs. 0.35) than their British counterparts. In contrast, British adults showed higher prevalence rates of poor health (0.18 vs. 0.12) and current smoking (0.28 vs. 0.21) than their American peers. The team found lesser socioeconomic differences in middle-age health among British adults than US adults.
For study outcomes like smoking, adults from the highest socioeconomic category in the US were fitter than the corresponding individuals in England. For outcomes like cholesterol and hypertension, the most socioeconomically privileged US adults fared equivalent to or inferior compared to the most socioeconomically deprived group in Britain.
University-level educational attainment was higher among parents of American participants than British participants (36% vs. 21%); the rates of university degree completion among participants were comparable (40% vs. 36%). Males tended to have higher cholesterol and blood pressure than females. Socioeconomic differences during mid-life health were higher for adulthood socioeconomic status than for childhood socioeconomic status. The predicted likelihood of current smoking and self-reporting poor health was higher for less educated adults with lower income.
In Britain, the prevalence of obesity was similar between middle- and low-income groups, whereas the highest-income quintile exhibited a significantly lower level of obesity. In the US, there was an income gradient across the distribution (lowest: 0.5, middle: 0.4, highest: 0.2). The findings revealed that midlife health disadvantages in the United States are similar to those reported at older ages.
The health disparity in the United States results from various individual-level causes (e.g., physical activity, food, and lifestyle behaviors) and wider societal determinants of health. The interaction of these processes remains a significant topic for future investigation.
Conclusions
The study findings, aligned with previous research, showed that US adults have poorer cardiometabolic profiles than their English peers, even during initial midlife. In contrast, British adults tend to practice unhealthy habits. However, socioeconomic differences in cardiometabolic health status and health behaviors are higher in the US.
The most socioeconomically privileged individuals in the United States often have comparable or worse self-reported health than British adults from the most socioeconomically deprived group in Britain.
The study findings have important implications for practice and policy, as they indicate that sociopolitical inequalities between the nations may drive differences in health profiles. The lesser disparities in socioeconomic position and better health among British people may reflect variations in access to healthcare services and welfare benefits.
England has the National Health Service, which is widely accessible and free at the point of use. Health care is primarily private in the US, and the expenses are frequently expensive, regardless of availability.
