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This Article Figures Only Full Text Full Text (PDF) Data Supplement All Versions of this Article: AJPH.2008.139469v1 99/3/540    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Avendano, M. Articles by Mackenbach, J. P. Search for Related Content PubMed PubMed Citation Articles by Avendano, M. Articles by Mackenbach, J. P. Related Collections Epidemiology Global Health Socioeconomic Factors

Mauricio Avendano, PhD, M. Maria Glymour, ScD, James Banks, PhD and Johan P. Mackenbach, PhD

Mauricio Avendano and Johan P. Mackenbach are with the Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands. Mauricio Avendano is also with the Center for Population and Development Studies, Harvard School of Public Health, Boston, MA. M. Maria Glymour is with the Department of Society, Human Development, and Health, School of Public Health, Harvard, Boston, MA, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. James Banks is with University College London, London, England, and the Institute for Fiscal Studies, London.

Correspondence: Requests for reprints should be sent to Mauricio Avendano, Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands (e-mail: m.avendanopabon{at}erasmusmc.nl).

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.

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