摘要：Objectives. We compared the health of older US, English, and other European adults, stratified by wealth. Methods. Representative samples of adults aged 50 to 74 years were interviewed in 2004 in 10 European countries (n = 17 481), England (n = 6527), and the United States (n = 9940). We calculated prevalence rates of 6 chronic diseases and functional limitations. Results. American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12% of English and 11% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95% CI = 1.73, 2.62) in England, and 1.38 (95% CI = 1.23, 1.56) in Europe. Smoking, obesity, physical activity levels, and alcohol consumption explained a fraction of health variations. Conclusions. American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans. The United States spends 2 to 3 times more than European countries on medical care per capita. 1 , 2 However, recent research indicates that US adults aged 55 to 64 years are less healthy than their English counterparts at all socioeconomic levels. 3 , 4 Less is known about how the health of adults in the United States and England compares with the health of other Europeans across the socioeconomic spectrum. Including other European countries in the analysis and examining the socioeconomic gradients within and between each region can shed light on possible explanations for between-country health differences. Several factors may explain why Americans have worse health than Europeans. 3 – 8 Although major risk factors such as smoking are similarly prevalent, 3 the obesity epidemic is more advanced in the United States than in Europe. 9 In addition, Europe's social and healthcare policies are more comprehensive and contrast with less accessible US programs. 4 , 10 Most notably, whereas healthcare access is universal in Europe, about 41 million Americans remain uninsured. 11 Furthermore, most European health care systems have a strong focus on primary care, which contrasts with a marked focus on specialist care in the United States. 12 – 14 Socioeconomic inequalities may be critical to understanding why Americans have worse health than Europeans. 3 , 5 European welfare policies may protect the health of poor Europeans—for example, through universal medical care, comprehensive primary care, and unemployment protection programs. 5 , 12 , 14 If safety net policies drive the US–Europe health gap, then we expect that poor Americans would report worse health than would poor Europeans but that wealthy Americans and wealthy Europeans would report equivalent health. Furthermore, we expected poverty to be associated with a smaller health disadvantage in European countries than in the United States. We used comparable surveys in the United States, England, and 10 other European countries to examine cross-country health variations by wealth and investigated how wealth–health associations differ among regions.
