Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 10869 CHAPTER 4 | CROSS-NATIONAL HEALTH DISPARITIES AND US DISADVANTAGE higher prevalence of disease compared to the English, but also a higher risk of new disease incidence. The incidence rates of disease are closer in the two countries in the older age group. Comparison of mortality, on the other hand, tells a somewhat different story. Age- specific mortality is only slightly higher in the US in the younger age group, and is actually lower in the older age group. This may suggest that investments in health care at older ages in the US helps offset earlier life health prob- lems. Another line of HRS research shows that health care utilization increases after age 65 when Americans become eligible for Medicare (McWilliams et al. 2007), which may help account for smaller cross-national differences in health at older ages. Work and marital status, as well as obesity, exercise and smoking explain income gradients for the younger groups in the US and the UK, and to a large extent in the 70- to 80-year-old Americans. For both birth cohorts and in both countries, many individuals who smoked in the past are able to stop. Yet relative to those with higher income and wealth, individuals with low- er income and wealth appear to have a harder time quitting. The absence of an SES gradient for the older cohort relates to the English system of income benefits, which raises the income floor for poorer households. Interestingly, a recent study using ELSA and HRS shows that the English health advantage is reduced signifi- cantly when data includes information about physical functioning (Cieza et al. 2015). Age-specific mortality is only slightly higher in the US in the younger age group, and is actually lower in the older age group. 0% 10% 20% 30% 40% 50% 60% Heart disease Stroke Hypertension Diabetes Cancer Lung disease 1+ IADL limitations 1+ mobiliy limitations US-HRS England-ELSA Europe-SHARE FIGURE 4-1  Prevalence of chronic disease and disability among those aged 50-74 in the US, England and Europe: 2004 Source: Avendano et al. (2009).