This dissertation documents population health patterns by age in the United States and England, explores how these patterns vary by race/ethnicity and socioeconomic status in each country, and investigates the extent to which risk factors account for differences in health outcomes in the two countries using the National Health and Nutrition Examination Survey (NHANES) and Health Survey for England (HSE). The attempt to understand and explain poor health outcomes and health disparities using an international comparative perspective is a novel and potentially fruitful approach. The recent increase in comparable micro data sources in both the United States and England has created a unique opportunity for comparative studies on health outcomes and health disparities in these two countries across the entire life span. There is a long tradition of population health studies in both countries, but research to date comparing morbidity in the United States and England has been fragmented by focusing on specific age groups and health outcomes.
Overall, this dissertation finds that the differences between the United States and England previously documented for older adults are present for all age groups, with the United States population experiencing worse health overall. Potential explanations such as variation in health insurance, alcohol consumption, smoking, and obesity did not explain the differences. However, the health differential between the two countries is significantly attenuated for several outcomes when comparing normal weight-only respondents (BMI 18.5-24.9), thus explaining some of the differences in the two countries. For individuals of normal body weight (40% of United States sample and 50% of English sample), Americans are as healthy as the English for a number of health outcomes.
In exploring the extent of disparities in health by race/ethnicity in the two countries by age group, the results demonstrate that ethnic minorities have worse health than whites on most outcomes. The disparities vary by racial/ethnic group, yet overall disparities between non-white minority groups and whites are very similar in the two countries and are robust to controls for socio-economic status and health behaviors.
Finally the socio-economic gradient in health in the two countries is examined, also from childhood through old age. In the socio-economic gradient analysis by age group, health is worse in the United States than in England at each socio-economic tercile for both men and women. Despite the differences in health in the two countries by socio-economic tercile, the gradient in England is about as steep as the gradient in the United States.
|Advisor:||Teitler, Julien O.|
|School Location:||United States -- New York|
|Source:||DAI-A 72/05, Dissertation Abstracts International|
|Subjects:||Social work, Public policy, Epidemiology, Demography|
|Keywords:||England, Health disparities, International health, Population health, United States|
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