Why are British men healthier than American ones? By Sydney Spiesel
Posted Monday, May 15, 2006, at 12:03 PM ET
Earlier this month, a study in the Journal of the American Medical Association compared the health of a group of men in the United States with that of a very similar group of men in England. The researchers found a striking difference in the quality of health of the two populationsthe Americans were sicker and died younger than their British counterparts. The results are anxiety-provoking because they can't easily be accounted forand because one of the study's authors, Dr. Michael Marmot of University College, London, is a giant in the field.
Marmot's new study compared two populations, one in England and one in the United States, totaling about 8,000 in all, with many similar characteristics. All were male, non-Latino whites between the ages of 55 and 64. The researchers curbed diversity in this way in order to weed out extraneous factors. But in each group, the men ranged widely in terms of income and educational attainment. Thus, though the study primarily compared the health consequences of living in the United States or living in England, the researchers also looked at the degree to which socioeconomic status contributed to the health differences they found.
Marmot and his co-authorsJames Banks, Zoe Oldfield, and James P. Smithasked the research subjects to self-report rates of diabetes, high blood pressure, heart disease, lung disease, stroke, and cancer. The researchers found that American men were far sicker with these chronic diseases than British men similar in age, ethnicity, and socioeconomic status. When these two groups were compared, the American men were worse off with respect to every disease the study included. Often, the differences were striking: 12.5 percent of the American men reported that they were diabetic, compared to 6.1 percent of the British men; the men in the United States were 1.25 times as likely to report high blood pressure, more than 1.5 times as likely to report heart disease, and 1.7 times as likely to report cancer.
Could the difference have been one of interpretationdo American and British men respectively exaggerate or underplay illness? To rule out this possible weakness of self-reporting, Marmot's team considered studies that examined lab test results, so they could objectively corroborate the reports of the patients in their own study. The team found that, in general, for both groups the level of self-reported illness and the laboratory findings closely matched. (For instance, in England, self-reporting of diabetes was 8 percent higher than diabetes confirmed by laboratory testing, while in the United States, the self-reported rate was 11 percent higher.) So, both self-reporting and lab results suggest the same thing: British men appear to be significantly less likely to suffer from chronic disease than similar Americans.
There are many ways in which these results are not at all what one would expect. For instance, the United States spends a great deal more on health care than England does2.4 times as much per capita. And other differences like the terrible state of British dentistry also ought to weigh in Americans' favor. It's long been suspected that dental and oral infections play a role in promoting heart disease and possibly stroke. Tooth loss can lead to poor nutrition and social isolation among the elderly, which increase the risk for illness and early death.
So, how do we account for the apparent better health of Englishmen? This study shows that the answer doesn't relate to race or ethnicity. The researchers also showed that neither smoking (Brits and Americans smoke in about equal numbers) nor overeating (Americans do this more than Brits) nor heavy drinking (here the Brits have the edge) could account for the difference.
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