文章基本信息

标题：Income Inequality in Health at All Ages: A Comparison of the United States and England
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作者：Melissa L. Martinson
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：102
期号：11
页码：2049-2056
DOI：10.2105/AJPH.2012.300929
语种：English
出版社：American Public Health Association
摘要：Objectives. I systematically examined income gradients in health in the United States and England across the life span (ages birth to 80 years), separately for females and males, for a number of health conditions. Methods. Using data from the National Health and Nutrition Examination Survey for the United States (n = 36 360) and the Health Survey for England (n = 55 783), I calculated weighted prevalence rates and risk ratios by income level for the following health risk factors or conditions: obesity, hypertension, diabetes, low high-density lipoprotein cholesterol, high cholesterol ratio, heart attack or angina, stroke, and asthma. Results. In the United States and England, the income gradients in health are very similar across age, gender, and numerous health conditions, and are robust to adjustments for race/ethnicity, health behaviors, body mass index, and health insurance. Conclusions. Health disparities by income are pervasive in England as well as in the United States, despite better overall health, universal health insurance, and more generous social protection spending in England. Population health is worse in the United States than England, despite the much higher level of health care spending in the United States. 1–3 Well-documented health differentials between the 2 countries exist for a wide variety of health measures at all ages. 3 However, questions remain about the extent of cross-country differences in health disparities, in particular whether income inequalities in health are higher in the United States than in England across the life span. Health comparisons between the United States and England are interesting because, despite many societal similarities, there are differences in health care provision, social protection policies, and societal inequality between the 2 countries. 4–6 In particular, previous studies have postulated that differences in health care systems between the United States and England (as well as other European countries) may account for the relatively poorer health in the United States as well as the greater health inequalities among Americans. 2,7–9 Additionally, whereas both countries have liberal, residual welfare states, Britain has slightly lower income inequality and a greater focus on alleviating poverty, particularly among children, although it still lags behind many other European countries. 5,10 A handful of studies have examined the magnitude of socioeconomic disparities in health in the United States and England, and the results are decidedly mixed. Banks et al. concluded that income- and education-based health gradients among older adults are steeper in the United States than in England, 1 whereas Avendano et al. found that the wealth gradient for older adults is similar in the 2 countries. 2 A series of articles examining the income gradient in health among children has produced conflicting findings. 7,11,12 One comparative study of self-rated health by income, occupational, and poverty status in the United States and United Kingdom included middle-age adults; it found better health in the United Kingdom than in the United States, as well as a greater likelihood of health improving over time in the United Kingdom. 13 However, that study did not examine the income gradient in health. No study to date has compared socioeconomic gradients in health throughout the life span in the United States and England. There is reason to believe that the income gradient in health is largest in middle to later adulthood, because the income gradient in health widens with age among children and narrows with age among the elderly because of increased mortality among low-income people. 11,12,14,15 This widening of income disparities with age would likely be similar in the United States and England if the income gradient age pattern is being driven by a higher vulnerability to health shocks among low-income individuals than among high-income individuals. However, if an increase in income disparities with age is due to low-income individuals’ lack of ability to respond to health shocks (e.g., through lack of insurance), one would expect to see a more rapid increase in income-based health inequalities in the United States than in England because of the highly variable US health care system. The extent to which income gradients in health and health trajectories differ in the 2 countries by age is not known, but it represents an important area of inquiry for understanding the processes leading to the well-documented cross-country differences in health. In this study, I describe and compare the extent of income-based socioeconomic gradients in health in the United States and England from birth to 80 years, for both females and males, using a large set of biological and self-reported health measures. This study provides a comprehensive description of the magnitude of income inequalities in health in the 2 countries.