Although the US spends far more on health care than other high-income countries, older Americans are sicker and have shorter lives than older adults in many other high-income countries, even after controlling for individual-level factors such as education and behavioral risks. Reasons for the US health disadvantage are not well understood. However, local amenities and resources have not been examined systematically in efforts to understand difference in older adults' health status across countries.
This project will assess the extent to which local contextual characteristics explain the worse health status of older Americans compared to their counterparts in England using data from the Health and Retirement Study (HRS) and English Longitudinal Study of Aging (ELSA). We will identify comparable local geographic areas in the HRS and ELSA and create a comparable contextual dataset to be linked to the ELSA at each geographic boundary. We will then assess the extent to which area-level contextual measures explain key health and mortality differences between the US and England, including comprehensive self-reported health measures, measures of physical performances (e.g., gait speed) and cognitive functioning, and biomarkers (e.g., HbA1c). We will also examine health gaps by age, education, and economic groups before and after the adjustments of local contextual characteristics.