A comparison of hypertension healthcare outcomes among older people in the USA and England

Abstract

Background The US and England have very different health systems. Comparing hypertension care outcomes in each country enables an evaluation of the effectiveness of each system. Method The English Longitudinal Study of Ageing and the Health and Retirement Survey are used to compare the prevalence of controlled, uncontrolled and undiagnosed hypertension in the population aged over 50 in the US and in England. Results Controlled hypertension is more prevalent in the US (age 50 to 64: 0.53 (0.50-0.57) and age 65+: 0.51 (0.49-0.53)) than in England (age 50 to 64: 0.45 (0.42-0.48) and age 65+: 0.42 (0.40-0.45)). This difference is driven by lower undiagnosed hypertension in the US (age 50 to 64: 0.18 (0.15-0.21) and age 65+: 0.13 (0.12-0.14)) relative to England (age 50 to 64: 0.26 (0.24-0.29) and age 65+: 0.22 (0.20-0.24)). The prevalence of uncontrolled hypertension is very similar in the US (age 50 to 64: 0.29 (0.26-0.32) and age 65+: 0.36 (0.34-0.38)) and England (age 50 to 64: 0.29 (0.26-0.32) and age 65+: 0.36 (0.34-0.39)). 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 US. 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 health care and are more equitable in the distribution of care outcomes. Higher undiagnosed hypertension among the affluent may reflect less frequent medical contact.