A recent study highlights that older Americans face more serious heart problems than their counterparts in Denmark, despite both countries offering government-sponsored healthcare. The study, published in JAMA Cardiology, compares the health outcomes of heart disease in the two nations.
Researchers from the University of Copenhagen and Harvard Medical School analyzed hospitalisation rates for heart attacks, heart failure, and ischemic stroke in adults aged 65 and older. The study included 1.2 million people in the US and 16,000 in Denmark.
The findings show that hospitalisation rates in the US were 1.5 times higher than in Denmark, with 20.8 hospitalisations per 1,000 people in the US compared to 13.9 in Denmark. Additionally, Americans were slightly more likely to die within 30 days of being hospitalised for heart-related issues.
This data aligns with the Global Burden of Disease study, which shows that cardiovascular disease death rates in Denmark were 20% lower than in the US. In 2021, Denmark’s death rate from heart disease was 221.8 per 100,000, compared to the US’s 272.3 per 100,000.
Wealth and Health System Disparities
The study points to income inequality and the structure of the healthcare system as key factors contributing to these differences. While higher-income Americans had slightly higher hospitalisation rates than wealthy Danes, the most significant disparities were seen in lower-income groups.
For example, low-income Danes had a heart failure hospitalisation rate of 7.2 per 1,000 people, while the rate for low-income Americans was significantly higher at 24 per 1,000. Dr. Gunnar Gislason, a cardiologist and one of the study’s authors, noted the striking nature of these differences.
Despite both nations being wealthy, the US has higher poverty rates and more income inequality, making healthcare access more challenging for many. The US health system is also more fragmented, with a mix of private, job-sponsored, and government-run health coverage. Millions of Americans lack health insurance altogether, leading to gaps in care that become harder to overcome in older age.
Access to Healthcare and Its Impact
Research has shown that uninsured Americans are less likely to receive care for high blood pressure and high cholesterol, both of which are key risk factors for heart disease. In contrast, Denmark offers universal healthcare, which provides equal access to services regardless of income, education, or employment status.
Dr. Filippo Crea, editor-in-chief of the European Heart Journal, explained that low socioeconomic status is a known risk factor for heart health issues. He emphasized that Denmark’s system benefits from low-cost medications and broad access to professional care, ensuring that healthcare doesn’t depend on a person’s financial situation.
Denmark spends about €343 per capita annually on cardiovascular disease, a figure in line with other EU countries. In contrast, older Americans are more likely to have high blood pressure, high cholesterol, and diabetes—factors that increase the risk of heart disease.
Different Patterns of Hospitalisation
While the US had higher hospitalisation rates for heart attacks and heart failure, Denmark had fewer hospitalisations for ischemic stroke. Dr. Gislason suggested this might be because less severe heart problems in Denmark are treated in outpatient clinics, whereas in the US, hospitalisation thresholds could be lower.
Dr. Crea also noted that Danes might be more aware of stroke symptoms, which could lead to earlier medical intervention.
Conclusion
Despite Denmark’s universal healthcare system being far from perfect, the study emphasizes that access to healthcare plays a crucial role in improving heart health outcomes. While income-related disparities in hospitalisation rates exist in both countries, they are narrower in Denmark. The findings call for targeted public health efforts to address cardiovascular health disparities, particularly for vulnerable populations in both the US and Denmark.
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