Older Adults in the United States Have Worse Cardiometabolic Health Compared to England

Explanations for lagging life expectancy in the United States compared to other high-income countries have focused largely on deaths of despair, but attention has also shifted to the role of stalling improvements in cardiovascular disease and the obesity epidemic. Using harmonized data from the U.S. Health and Retirement Study and English Longitudinal Study of Ageing, we assess differences in self-reported and objective measures of health, among older adults in the United States and England and explore whether the differences in body mass index (BMI) documented between the United States and England explain the U.S. disadvantage. Older adults in the United States have a much higher prevalence of diabetes, low high-density lipoprotein cholesterol, and high inflammation (C-reactive protein) compared to English adults. While the distribution of BMI is shifted to the right in the United States with more people falling into extreme obesity categories, these differences do not explain the cross-country differences in measured biological risk. We conclude by considering how country differences in health may have affected the burden of coronavirus disease 2019 mortality in both countries.

Automated summary

There are significant differences in health between older adults in the United States and England, including higher prevalence of diabetes, low high-density lipoprotein cholesterol, and high inflammation in the United States. Although extreme obesity is more common in the United States, differences in body mass index (BMI) cannot fully explain the cross-country differences in measured biological risk.