BOX 1-1The U.S. Morbidity Disadvantage

As of 2010, the United States had the highest prevalence of diabetes (for adults aged 20–79) among the 17 peer countries (and among all OECD countries except Mexico). The U.S. obesity epidemic probably plays a major role in the prevalence of diabetes. The United States has the highest prevalence of adult obesity among the 17 peer countries (and all other OECD countries), a position it has held for decades. As of 2009, the prevalence of obesity in the United States (33.8 percent) was twice the OECD average (16.9 percent) (OECD, 2011b).

In a comparison of the health of Americans and the English across the life span, from birth to age 80, the United States had a higher prevalence of obesity, lipid disorders, diabetes, and asthma (Martinson et al., 2011a). Among females, the United States also had a higher prevalence of hypertension, heart attack and angina, and stroke. The differences were as large for young people as for old people. The researchers found that the English advantage persisted even when the samples were restricted to whites, people with health insurance, nonsmokers, nondrinkers, individuals of normal weight, or those in specific income categories (Martinson et al., 2011a, 2011b).

Studies of risk factors, rather than diseases, have yielded more mixed results. For example, some studies find that hypertension is less common in the United States than in other countries (Danaei et al., 2011a; Wolf-Maier et al., 2003), while others report the opposite (Banks et al., 2006; Martinson et al., 2011a). Similarly, some studies report that serum lipid levels are lower in the United States than in other countries (Farzadfar et al., 2011; Martinson et al., 2011a), but another study that compared biological risk factors in American and Japanese adults over age 20 found that Americans had a higher summary risk score, including higher levels of serum lipids, glycosylated hemoglobin, and obesity, especially before age 50 (Crimmins et al., 2008).*

The percentage of American adults who describe their health as “good” or “very good” is the highest among people in high-income countries (OECD, 2011b), but this metric is subject to some limitations. Questions about self-rated health may be answered differently across countries due to cultural differences—such as differences in the likelihood or threshold for reporting good health—and may not always track well with objective health indicators. Danish residents, for example, are known to have shorter life expectancy than people in many other countries, but they are more likely to report their health as good or excellent (Oksuzyan et al., 2010). To some extent, this paradox may reflect attitudinal differences across cultures about the relative importance of physical health for a satisfying life. Self-rated health is influenced by mental health, which may differ in the United States from other countries. Finally, questions have been raised about the statistical validity of questions about self-rated health when presented to subjects of varied nationalities. The significance of the high self-rated health of Americans is therefore not entirely clear.


Some of these inconsistencies may reflect cross-national differences in treatment patterns. Americans with hypertension and hyperlipidemia may be more likely than others to receive medication for these conditions (see Chapter 4), and this may account for lower levels of blood pressure and serum lipids observed in some studies.

From: 1, Shorter Lives

Cover of U.S. Health in International Perspective
U.S. Health in International Perspective: Shorter Lives, Poorer Health.
National Research Council (US); Institute of Medicine (US); Woolf SH, Aron L, editors.
Washington (DC): National Academies Press (US); 2013.
Copyright © 2013, National Academy of Sciences.

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