b'CHAPTER 4 | CROSS-NATIONAL HEALTH DISPARITIES AND US DISADVANTAGE(Savva et al. 2013). The same measure of imme- Americans are more likely than Europeans and diate recall used in Langa et al. (2009) is used,the English to report that a doctor told them but a new measure of verbal fluency added to thethey had hypertension and high blood cholester-surveys later is also used. This task asks partic- ol levels (Crimmins, Garcia and Kim 2010). Yet, ipants to name as many items from a particularwhen objectively measured hypertension and high category as possible in 60 seconds. They also useblood cholesterol are considered, Americans have a measure of self-reported assessment of memoryamong the lowest levels of these conditions across as excellent, very good, good, fair or poor. Inall countries studied. It may be that Americans contrast to Langa et al. (2009), they find no signif- are more likely to be taking drugs to control hy-icant difference on the measure of immediatepertension and high cholesterol. recall, and those in England and Ireland scoreOther research using HRS sister-study data better than Americans on the measure of verbalconfirms that treatment rates are relatively high fluency. The English are the most likely to reportin the US. Thorpe et al. (2007) use data from HRS fair or poor memory, however. Unlike findingsand SHARE to examine differences in disease from other studies of educational inequality inprevalence and treatment rates for heart disease, physical health, the difference in cognitive scoreshigh blood pressure, stroke, diabetes, chronicbetween the US and Europe are very different, across educational levels is larger in England andlung disease and arthritis. They calculate treatedespecially in screening recommendations for Ireland than in the US. prevalence by multiplying the prevalence of theolder individuals. Most European cancer screen-condition by the prevalence of medication use;ing programs have firm upper age limits (usually treated prevalence is higher in the US for allbetween ages 60 and 70), whereas US guidelines Treated prevalence is higher inconditions. only suggest less screening at older ages. Indeed, the US for all conditions. In the US, the expansion of coverage for pre- Americans over age 50 receive more cancer scription drugs with Medicare Part D means thatscreening overall compared to their European control of blood pressure may improve further.counterparts. This is true at younger as well as Diebold (2016) finds that not taking medicationsolder ages. For example, mammography screen-Detecting and Treating because of cost decreased by 7% in those newlying rates are 77% for 50- to 64-year-old women More Disease covered by Part D. This translated into a 4%in the US, while only 46% in Europeans of the Disease prevalence results from a combination ofdecline in the likelihood of being diagnosed same age. The prevalence of mammography is incidence (new disease) and duration of disease.with high blood pressure. 13% for Europeans over age 76, but is 58.5% for Better treatment of chronic diseases can meanAnother study uses these data to evaluateolder Americans. that people with these diseases live longer. Somecross-national differences in cancer screening evidence suggests that the treatment rates forrates (Howard et al. 2009). More aggressive these conditions may be higher in the US. Thisscreening could lead to a higher rate of diseaseAmericans over age 50 receive more may translate to a survival advantage, espe- detection and earlier detection, both of whichcancer screening overall compared to cially at older ages, and could help explain thecould contribute to higher disease prevalence attheir European counterparts.higher prevalence of chronic disease in the US.a given point in time. Medical practice guidelines 75'