Older adults who live in the United States are significantly more likely than their European peers to be diagnosed with costly chronic diseases, such as cancer, diabetes, and heart disease, and to be treated for those diseases, adding approximately $100-$150 billion per year in U.S health care spending, according to new research reported in a Health Affairs Web Exclusive. Americans are also nearly twice as likely as those who live in Europe to be obese, say Emory University Rollins School of Public Health researchers in the first study of its kind.

Department of Health Policy and Management chair Kenneth Thorpe and team compared 2004 data on the prevalence and treatment of diseases among adults age 50 and older in the U.S. and 10 European countries (Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, and Switzerland). They found that while 17.1 percent of European adults are obese, the rate is nearly double for American adults -- 33.1 percent. More than half (53 percent) of adult Americans are former or current smokers. In Europe, the rate is 43 percent. American adults were also more likely than Europeans to have chronic diseases, such as heart disease, cancer, diabetes, and chronic lung disease, that are correlated with obesity and smoking.

The United States spends more on health care than any country in Europe, according to Organization for Economic Cooperation and Development (OECD) data. In 2004, U.S. per capita spending on health care was $6,102 -- about twice the rate in the Netherlands and Germany and nearly twice that of France.

"We expected to see differences between disease prevalence in the United States and Europe, but the extent of the differences is surprising," Thorpe said. "It is possible that we spend more on health care because we are, indeed, less healthy. If the U.S. could bring its obesity rates more in line with Europe's, it could save $100 billion a year or more in health care costs."

More specifically, the researchers estimated that per capita U.S. spending could be reduced by $1,195 to $1,750 per year if Americans age 50 and older were diagnosed and treated at the lower European rates for 10 common chronic conditions: heart disease; high blood pressure; high cholesterol; stroke/cerebrovascular disease; diabetes; chronic lung diseases; asthma; arthritis; osteoporosis; and cancer. Thorpe and colleagues estimate that this would reduce health spending by $100-$150 billion per year or would trim 12.7-18.7 percent off the total budget for personal health care spending among those age 50 and older.

Why Is Disease Prevalence Higher In The U.S.?

Explanations for the differences in disease prevalence remain varied. While it is possible that Americans are actually sicker than Europeans, it is also possible that more aggressive diagnosis and pretreatment of chronic diseases in this country raises disease prevalence rates, the researchers say.

Thorpe and coauthors David Howard and Katya Galactionova also note that higher U.S. disease prevalence rates may vary by condition. For example, Americans have higher levels of obesity-related disease markers, such as high blood pressure, so they appear to be actually sicker than Europeans. On the other hand, the higher rate of diagnosed cancer in the United States -- more than double that of Europe -- appears to be due to more intensive screening here.

Researchers also found that the differences in the prevalence of chronic diseases affected the amount of medications used and treatments for those diseases. Despite the lack of universal health coverage in the United States, Americans age 50 and older were more likely than European adults to receive medications for six of nine conditions, including heart disease, diabetes, and asthma. This increased treatment for chronic disease and medication use is helping drive higher health care spending in the U.S., the researchers conclude.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at http://www.healthaffairs.org. Copies of the October 2, 2007 Web Exclusive article will be provided free to interested members of the press.