In the US but not in England, patients on low incomes with high blood pressure have their condition managed poorly compared with those who earn more.
A new study comparing blood pressure management in the US and England found that although there is little difference between the two countries overall, the level of socioeconomic inequality is much higher in the US, with wealthier Americans more likely to meet targets for bringing their blood pressure under control than poorer patients.
The study, by Imperial College London researchers, is published in the journal PLOS ONE.
High blood pressure, or hypertension, is the leading cause of ill health worldwide and affects 76 million people in the US and 16 million in the UK. It is diagnosed if someone's blood pressure consistently measures 140/90 millimetres of mercury or higher. Doctors usually recommend lifestyle changes to control blood pressure, and may prescribe antihypertensive drugs.
The research aimed to determine whether differences between the British and American health systems influence the quality of hypertension management and disparities between socioeconomic groups, using data from national surveys.
People aged 65 and over, who have universal coverage through Medicare in the US, were considered separately from those aged 50-64, who have varying coverage under a market-based system. In England, the National Health Service offers universal health coverage with free care at the point of delivery for all ages.
In over-65s, American patients with hypertension were modestly more likely to meet clinical targets for blood pressure control than those in England. In patients aged 50-64, there was no significant difference between the countries.
However, in both age groups in the US, wealthier patients were more likely to meet targets for bringing their blood pressure under control than poorer patients. There was no disparity based on wealth or income in English patients.
Lead author Dr Andrew Dalton, now at Oxford University, said: "These findings show that for patients with high blood pressure, the English universal healthcare model provides a similar quality of care to the US market-based system, but does so much more equitably across the population."
Dr Christopher Millett, the senior author of the study, from the School of Public Health at Imperial College London, said: "Our finding of equitable care for hypertension in England is probably due to the strong primary care system and the negligible cost of care to patients in the NHS, features lacking in the US system. The findings suggest that the US competitive market approach being introduced into the NHS may not produce the improvements in quality the government is hoping for and could reduce equity in care between poor and rich groups."
For more information please contact:
Research Media Officer
Imperial College London
Tel: +44(0)20 7594 2198
Out of hours duty press officer: +44(0)7803 886 248
Notes to editors
1. A.R.H. Dalton et al. 'Impact of universal health insurance coverage on hypertension management: a cross-national study in the United States and England.' PLOS ONE, 2014. After the embargo, the paper will be available at http://dx.plos.org/10.1371/journal.pone.0083705
2. About Imperial College London
Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research that attracts 14,000 students and 6,000 staff of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.
Since its foundation in 1907, Imperial's contributions to society have included the discovery of penicillin, the development of holography and the foundations of fibre optics. This commitment to the application of research for the benefit of all continues today, with current focuses including interdisciplinary collaborations to improve global health, tackle climate change, develop sustainable sources of energy and address security challenges.
In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.