A new study by researchers on both sides of the Atlantic found that while older English people enjoy better health than their American counterparts, they die sooner, adding fuel to the debate about which country’s health system takes better care of the elderly.

The results of the study, by researchers from the US-based nonprofit RAND Corporation and the Institute for Fiscal Studies in London, appeared online in the journal Demography this week.

Co-author James P. Smith, who holds the distinguished chair in Labor Markets and Demographic Studies at RAND, said in a statement that their findings show:

“If you get sick at older ages, you will die sooner in England than in the United States.”

He said if you measure success in terms of surviving longer with chronic disease in old age, it appears that the American health system is better than the English one.

Smith and co-authors James Banks and Alastair Muriel of the Institute for Fiscal Studies, found that while Americans aged from 55 to 64 had higher rates of chronic diseases than their counterparts in England, they died at about the same rate. And in the 65 plus group, although again, they were not as healthy as their peers in England, rates of death were lower among the Americans.

For the study, the researchers used data from two surveys of people aged 50 and over: the Health and Retirement Survey in the US and the English Longitudinal Survey of Ageing, and looked at disease rates among two groups: the 55 to 64-year olds and the 70 to 80-year olds.

The researchers looked at three things: the prevalence of disease, that is what proportion of these groups were sick (something they have looked at before in earlier studies); the incidence of new illnesses (something they had not looked at before, for which they examined the period 2002 to 2006); and the trends in death rates, for the US and England.

The diseases they studied included: diabetes, high blood pressure, heart attack, stroke, heart disease, lung diseases and cancer.

The results showed that:

  • For the diseases studied, both prevalence and incidence were higher among Americans.

  • There was a higher prevalence of diseases among both 55 to 64-year old Americans, and 70 to 80-year old Americans compared to the English.

  • Among 70 to 80-year olds, rates of diabetes were nearly twice as high in the US (17.2 per cent) as in England (10.4 per cent), and cancer rates were more than twice as high in the US (17.9 per cent) than in England (7.8 per cent).

  • In contrast, rates of death by age were similar in the two countries, with an even higher risk emerging among English people aged 65 and over.

The researchers suggested two possible explanations for the higher rates of death in England in the 65 plus age group. It could be that this was true only for the illnesses they studied, or it could be that the diseases that people die of in that age group are diagnosed earlier in America.

Smith said both explanations support the idea that medical care in the US is better quality than in England, at least in the sense that “these chronic illnesses are less likely to cause death among people living in the United States”, he clarified.

Banks suggested this shows that the problem with the US healthcare system for the elderly is not to do with health care or insurance, but to do with “excess illness”, and improving health care delivery will not necessarily make it go away.

“The solution may be to alter lifestyles or other behaviors,” said Banks.

The researchers also looked at the link between people’s financial resources in the two countries and risk of death in the future.

They found that poorer individuals are more likely to sooner than wealthier counterparts, but suggest their findings support the idea that the main link between health and wealth is that poor health depletes the income coming into a household, and not that low income causes health to decline.

They said the significant rise in wealth that took place in the US between 1992 and 2002, due to increases in share and house prices, did not change the risk of death later.

The National Institute on Aging in the US and the Economic and Social Research Council in the UK paid for the study.

“Disease Prevalence, Disease Incidence, and Mortality in the United States and in England.”
James Banks, Alastair Muriel, James P. Smith.
Demography, Volume 47, Supplement, 2010, pp S211-S231
DOI: 10.1353/dem.2010.0008

Additional source: RAND Corporation.

Written by: Catharine Paddock, PhD