, Volume 52, Issue 2, pp 593–611 | Cite as

Disease Incidence and Mortality Among Older Americans and Europeans

  • Aïda Solé-AuróEmail author
  • Pierre-Carl Michaud
  • Michael Hurd
  • Eileen Crimmins


Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79.


Disease incidence Disease-specific survival Europe United States 



The authors acknowledge funding from NIA R01 AG040176-02, funding provided from the Spanish Ministry of Science and Innovation (ECO2010-21787-C03-01), and the Beatriu de Pinós Grant 2010-2012. An earlier version of this article was presented at the annual meeting of the Population Association of America, held in San Francisco, May 3–5, 2012. The SHARE data collection has been primarily funded by the European Commission through the fifth framework program (project QLK6-CT-2001-00360 in the thematic program Quality of Life). Further support by the European Commission through the sixth framework program (projects SHARE-I3, RII-CT-2006-062193, as an Integrated Infrastructure Initiative, COMPARE, CIT5-CT-2005-028857, as a project in Priority 7, Citizens and Governance in a Knowledge Based Society, and SHARE-LIFE (CIT4-CT-2006-028812)), and through the seventh framework program (SHARE-PREP (No 211909) and SHARE-LEAP (No 227822)) is gratefully acknowledged. Substantial co-funding for add-ons, such as the intensive training program for SHARE interviewers, came from the U.S. National Institute on Aging (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11, and OGHA 04-064). Support for the HRS data collection was primarily provided by the National Institute on Aging (U01 AG009740).

Supplementary material

13524_2015_372_MOESM1_ESM.docx (838 kb)
Online Resource 1 (DOCX 837 kb)


  1. Adams, P., Hurd, M. D., McFadden, D., Merrill, A., & Ribeiro, T. (2003). Healthy, wealthy, and wise? Tests for direct causal paths between health and socioeconomic status. Journal of Econometrics, 112, 3–56.CrossRefGoogle Scholar
  2. Banks, J., Marmot, M., Oldfield, Z., & Smith, J. P. (2006). Disease and disadvantage in the United States and in England. Journal of the American Medical Association, 295, 2037–2045.CrossRefGoogle Scholar
  3. Banks, J., Muriel, A., & Smith, J. P. (2010). Disease prevalence, disease incidence, and mortality in the United States and in England. Demography, 47, 211–231.CrossRefGoogle Scholar
  4. Crimmins, E. M., Garcia, K., & Kim, J. K. (2010a). Are international differences in health similar to international differences in life-expectancy? In E. M. Crimmins, S. H. Preston, & B. Cohen (Eds.), International differences in mortality at older ages: Dimensions and sources (pp. 68–102). Washington, DC: National Academies Press.Google Scholar
  5. Crimmins, E. M., Preston, S. H., & Cohen, B. (2010b). International differences in mortality at older ages: Dimensions and sources. Washington, DC: National Academies Press.Google Scholar
  6. Glei, D. A., Meslé, F., & Vallin, J. (2010). Diverging trends in life expectancy at age 50: A look at causes of death. In E. M. Crimmins, S. H. Preston, & B. Cohen (Eds.), International differences in mortality at older ages: Dimensions and sources (pp. 17–67). Washington, DC: National Academies Press.Google Scholar
  7. Health and Retirement Study (2011). Sample sizes and response rates. Retrieved from
  8. Huber, M., Rodrigues, R., Hoffmann, F., Gasior, K., & Marin, B. (2009). Facts and figures on long-term care in Europe and North America. Vienna, Austria: European Centre for Social Welfare Policy and Research. Retrieved from Google Scholar
  9. Human Mortality Database. (n.d.). University of California, Berkeley (USA), and Max Planck Institute for Demographic Research (Germany). Retrieved from or
  10. Little, R. J., & Rubin, D. B. (1987). Statistical analysis with missing data. New York, NY: Wiley.Google Scholar
  11. Manton, K. G., Stallard, E., & Vaupel, J. W. (1986). Alternative models for the heterogeneity of mortality risks among the aged. Journal of the American Statistical Association, 81, 635–644.CrossRefGoogle Scholar
  12. Thorpe, K. E., Howard, D. H., & Galactionova, K. (2007). Differences in disease prevalence as a source of the U.S.-European health care spending gap. Health Affairs, 26(6), w678–w686. doi: 10.1377/lthaff.26.6.w678 CrossRefGoogle Scholar

Copyright information

© Population Association of America 2015

Authors and Affiliations

  • Aïda Solé-Auró
    • 1
    Email author
  • Pierre-Carl Michaud
    • 2
  • Michael Hurd
    • 3
  • Eileen Crimmins
    • 4
  1. 1.Pompeu Fabra UniversityBarcelonaSpain
  2. 2.Département des sciences économiquesUniversité du Québec à Montréal and RANDMontréalCanada
  3. 3.RAND and NBERSanta MonicaUSA
  4. 4.Davis School of Gerontology, University of Southern CaliforniaLos AngelesUSA

Personalised recommendations