title: Comparison of hypertension healthcare outcomes among older people in the USA and England.
abstract: BACKGROUND
  The USA and England have very different health systems. Comparing hypertension care outcomes in each country enables an evaluation of the effectiveness of each system.
  
  
  METHODS
  The English Longitudinal Study of Ageing and the Health and Retirement Survey are used to compare the prevalence of controlled, uncontrolled and undiagnosed hypertension within the hypertensive population (diagnosed or measured within the survey data used) aged 50 years and above in the USA and in England.
  
  
  RESULTS
  Controlled hypertension is more prevalent within the hypertensive population in the USA (age 50-64: 0.53 (0.50 to 0.57) and age 65+: 0.51 (0.49 to 0.53)) than in England (age 50-64: 0.45 (0.42 to 0.48) and age 65+: 0.42 (0.40 to 0.45)). This difference is driven by lower undiagnosed hypertension in the USA (age 50-64: 0.18 (0.15-0.21) and age 65+: 0.13 (0.12 to 0.14)) relative to England (age 50-64: 0.26 (0.24 to 0.29) and age 65+: 0.22 (0.20 to 0.24)). The prevalence of uncontrolled hypertension within the hypertensive population is very similar in the USA (age 50-64: 0.29 (0.26 to 0.32) and age 65+: 0.36 (0.34 to 0.38)) and England (age 50-64: 0.29 (0.26 to 0.32) and age 65+: 0.36 (0.34 to 0.39)). Hypertension care outcomes are comparable across US insurance categories. In both countries, undiagnosed hypertension is positively correlated with wealth (ages 50-64). Uncontrolled hypertension declines with rising wealth in the USA.
  
  
  CONCLUSIONS
  Different diagnostic practices are likely to drive the cross-country differences in undiagnosed hypertension. US government health systems perform at least as well as private healthcare and are more equitable in the distribution of care outcomes. Higher undiagnosed hypertension among the affluent may reflect less frequent medical contact.
authors.affiliation: Department of Geography and Sustainable Development, University of St Andrews, St Andrews, Fife, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Marshall
authors.affiliation: Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK.
authors.forename: James
authors.initials: J
authors.lastname: Nazroo
authors.affiliation: RAND Corporation, Santa Monica, California, USA Department of Demography, University of California, Berkeley, California, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Feeney
authors.affiliation: RAND Corporation, Santa Monica, California, USA University of Southern California, Davis School of Gerontology, Los Angeles, California, USA.
authors.forename: Jinkook
authors.initials: J
authors.lastname: Lee
authors.affiliation: Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK.
authors.forename: Bram
authors.initials: B
authors.lastname: Vanhoutte
authors.affiliation: Institute of Brain, Behaviour and Mental Health, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
mesh_terms: D000368:Aged; D000375:Aging; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D004739:England / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D011788:Quality of Life; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: ACCESS TO HLTH CARE; Health inequalities; PUBLIC HEALTH