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Popul Health Metr. 2007 Oct 16;5:10. doi: 10.1186/1478-7954-5-10.

Comparing the health of low income and less well educated groups in the United States and Canada.

Eng K#1, Feeny D#1,2,3,4.

Author information

Institute of Health Economics, Edmonton, AB, Canada.
Departments of Economics and Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
Kaiser Permanente Northwest Centre for Health Research, Portland Oregon, USA.
Health Utilities Incorporated, Dundas, Ontario, Canada.
Contributed equally



A limited number of health status and health-related quality of life (HRQL) measures have been used for inter-country comparisons of population health. We compared the health of Canadians and Americans using a preference-based measure.


The Joint Canada/United States Survey of Health (JCUSH) 2002-03 conducted a comprehensive cross-sectional telephone survey on the health of community-dwelling residents in Canada and the US (n = 8688). A preference-based measure, the Health Utilities Index Mark 3 (HUI3), was included in the JCUSH. Health status was analyzed for the entire population and white population only in both countries. Mean HUI3 overall scores were compared for both countries. A linear regression determinants of health model was estimated to account for differences in health between Canada and the US. Estimation with bootstraps was used to derive variance estimates that account for the survey's complex sampling design of clustering and stratification.


Income is associated with health in both countries. In the lowest income quintile, Canadians are healthier than Americans. At lower levels of education, again Canadians are healthier than Americans. Differences in health among subjects in the JCUSH are explained by age, gender, education, income, marital status, and country of residence.


On average, population health in Canada and the US is similar. However, health disparities between Canadians and Americans exist at lower levels of education and income with Americans worse off. The results highlight the usefulness of continuous preference-based measures of population health such as the HUI3.

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