6.   Obesity and diabetes: For decades, the United States has had the highest obesity rate among high-income countries. High prevalence rates for obesity are seen in U.S. children and in every age group thereafter. From age 20 onward, U.S. adults have among the highest prevalence rates of diabetes (and high plasma glucose levels) among peer countries.

7.   Heart disease: The U.S. death rate from ischemic heart disease is the second highest among the 17 peer countries. Americans reach age 50 with a less favorable cardiovascular risk profile than their peers in Europe, and adults over age 50 are more likely to develop and die from cardiovascular disease than are older adults in other high-income countries.

8.   Chronic lung disease: Lung disease is more prevalent and associated with higher mortality in the United States than in the United Kingdom and other European countries.

9.   Disability: Older U.S. adults report a higher prevalence of arthritis and activity limitations than their counterparts in the United Kingdom, other European countries, and Japan.

The first half of the above list occurs disproportionately among young Americans. Deaths that occur before age 50 are responsible for about two-thirds of the difference in life expectancy between males in the United States and peer countries, and about one-third of the difference for females. And the problem has been worsening over time; since 1980, the United States has had the first or second lowest probability of surviving to age 50 among the 17 peer countries. Americans who do reach age 50 generally arrive at this age in poorer health than their counterparts in other high-income countries, and as older adults they face greater morbidity and mortality from chronic diseases that arise from risk factors (e.g., smoking, obesity, diabetes) that are often established earlier in life.

The U.S. health disadvantage is more pronounced among socioeconomically disadvantaged groups, but even advantaged Americans appear to fare worse than their counterparts in England and some other countries. That is, Americans with healthy behaviors or those who are white, insured, college-educated, or in upper-income groups appear to be in worse health than similar groups in comparison countries.

Certain factors do not appear to be responsible for the U.S. health disadvantage. The United States has higher survival after age 75 than do peer countries, and it has higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income. In addition, U.S. suicide rates do not exceed the international average. Finally, the nation’s large population of recent immigrants is generally in better health than native-born Americans.



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