The US Health Disadvantage in the Early Life Course: A Comparison of Cardiovascular Wellness in the United States and England

Background/Purpose: The US health disadvantage in disease and mortality has gained a great deal of attention over the past 10 years. The United States ranks poorly on many indicators of health compared to other OECD countries despite significantly higher levels of health care spending. This crisis has been exacerbated by a notable decline in life expectancy in recent years. While fierce debates about why life expectancy is dropping in the United States have captured the attention of population health researchers, less attention has been focused on the pernicious disparity in morbidity indicators between the United States and its peers. While great attention has been focused on “diseases of despair” increasing mortality in the United States, other research has shown that lack of progress on cardiovascular health indicators has played a pivotal role in the declining health of Americans compared to their peers in other countries.

Previous research suggests the disparity between the health of US residents and the health of residents in other wealthy countries takes hold early in life. Yet, comparative research to understand the US health disadvantage in childhood, adolescence, and early adulthood is lacking, largely due to data limitations. This paper will share the results of a study which compares the health disadvantage (in the form of Ideal Cardiovascular Health) at early ages between the United States and England. First the paper documents the poor relative status of the United States compared to England among adolescents and young adults, and second, examines how socio-economic position and poverty influence patterns in cardiovascular wellness at early ages in the two countries.

Methods: The proposed study uses nationally representative health data from the National Health and Nutrition Examination Survey and the Health Survey of England that takes advantage of detailed questionnaire, body measurement, and blood sample measures. Specifically, the proposed study utilizes a new measure of cardiovascular wellness, ideal cardiovascular health, which is one of the key dimensions of health where the United States is struggling. We estimate logistic regression models and calculate predicted probabilities of less than ideal cardiovascular health in both countries for adolescents (age 12-19) and young adults (age 20-30) controlling for a number of factors important to population health. We include a number of sociodemographic and behavioral variables important to population health in all models.

Results: The results demonstrate the US disadvantage in cardiovascular wellness is present by adolescence. While children in socio-economically disadvantaged families have higher rates of poor cardiovascular health indicators than their more advantaged counterparts in both countries, all children in the United States suffer compared to their peers in England. These results are robust to the inclusion of a wide variety of control variables known to be important to population health.

Conclusions and Implications: These results have important implications for intervention points for cardiovascular health in childhood and adolescence. The potential for successful social and behavioral interventions in families and schools holds promise at these early ages.