5.   Drug-related mortality: Americans lose more years of life to alcohol and other drugs than people in peer countries, even when deaths from drunk driving are excluded.

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. Beginning at age 20, Americans have among the highest prevalence rates of diabetes (and high plasma glucose levels) among people in all OECD 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 experience 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 several other European countries.

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

The evidence for some other health indicators is less clear or mixed. Some studies suggest that the United States may also have higher rates of mental illnesses and asthma than comparable countries. The prevalence of cancer is also higher in the United States than in other countries, but this finding may reflect more intensive cancer screening practices. The United States also has a higher prevalence of strokes, which may reflect better survival rates with treatment.

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 other high-income countries and about one-third of the difference for females. Americans reach age 50 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. These findings underscore the importance of early life interventions, but there is also considerable evidence to support the importance of mid- and late-life interventions (such as smoking cessation) in addressing the U.S. health disadvantage.

The U.S. health disadvantage is more pronounced among socioeconomically



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