BOX 1-1
The U.S. Morbidity Disadvantage

As of 2010, the United States had the highest prevalence of diabetes (for adults aged 20-79) among the 17 peer countries (and among all OECD countries except Mexico). The U.S. obesity epidemic probably plays a major role in the prevalence of diabetes. The United States has the highest prevalence of adult obesity among the 17 peer countries (and all other OECD countries), a position it has held for decades. As of 2009, the prevalence of obesity in the United States (33.8 percent) was twice the OECD average (16.9 percent) (OECD, 2011b).

In a comparison of the health of Americans and the English across the life span, from birth to age 80, the United States had a higher prevalence of obesity, lipid disorders, diabetes, and asthma (Martinson et al., 2011a). Among females, the United States also had a higher prevalence of hypertension, heart attack and angina, and stroke. The differences were as large for young people as for old people. The researchers found that the English advantage persisted even when the samples were restricted to whites, people with health insurance, nonsmokers, nondrinkers, individuals of normal weight, or those in specific income categories (Martinson et al., 2011a, 2011b).

Studies of risk factors, rather than diseases, have yielded more mixed results. For example, some studies find that hypertension is less common in the United States than in other countries (Danaei et al., 2011a; Wolf-Maier et al., 2003), while others report the opposite (Banks et al., 2006; Martinson et al., 2011a). Similarly, some studies report that serum lipid levels are lower in the United States than in other countries (Farzadfar et al., 2011; Martinson et al., 2011a), but another study that compared biological risk factors in American and Japanese adults over age 20

between ages 15 and 59 were lower than those in nine economically comparable nations. Kunitz and Pesis-Katz (2005) reported that Americans have a shorter life expectancy than their neighbors in Canada. Meslé and Vallin (2006) and Rau et al. (2008) reported that, from 1980 to 2006, life expectancy in the United States grew more slowly than in almost every other high-income country.

The most extensive and recent analysis was a report by the National Research Council (2011). As noted in the Introduction of this report, that earlier report analyzed how life expectancy at age 50 had changed between 1980 and 2007, noting that it had increased by only 2.5 years in the United States compared with increases of 6.4 years in Japan, 5.2 years in Italy, and an average of 3.9 years in nine high-income countries other than the United



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