Older people are more likely to face serious heart problems in the US than in Denmark
Older Americans and Danes might both have government-sponsored healthcare, but the United States still lags behind the Scandinavian nation when it comes to health outcomes, according to a new study.
The findings, published in the journal JAMA Cardiology, offer insight into how different health systems – one fully public and the other a public-private hybrid – translate to health outcomes for heart disease, which is the top cause of death in the US and second leading cause in Denmark.
Researchers from the University of Copenhagen in Denmark and Harvard Medical School in the US compared hospitalisation rates for heart attacks, heart failure, and ischemic stroke – when blood supply is reduced, preventing oxygen from getting to the brain – among adults 65 and older in both countries.
They included about 1.2 million people in the US and 16,000 in Denmark.
The hospitalisation rate was 1.5 times higher in the US than in Denmark, with a respective 20.8 and 13.9 hospitalisations per 1,000 people, according to the study.
Americans were also slightly more likely than Danes to die within 30 days of being hospitalised.
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That’s in line with data from the Global Burden of Disease study, which shows that in 2021, the death rate from cardiovascular diseases was 221.8 per 100,000 in Denmark – 20 per cent lower than in the US (272.3).
Wealth and health system structure key factors
The new study indicates wealth gaps, and how the health systems are structured, may help explain these differences.
While higher-income Americans had slightly higher hospitalisation rates compared with wealthy Danes, the biggest disparities occurred among lower income residents.
When it comes to heart failure, for example, low income Danes had a hospitalisation rate of 7.2 per 1,000. For Americans, that figure shot to 24 per 1,000.
“These are really big differences,” Dr Gunnar Gislason, a cardiologist and one of the study’s authors, told Euronews Health.
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The researchers offered a few potential reasons behind the results.
While the US and Denmark are both among the wealthiest nations in the world, the US has a higher poverty rate and more income inequality, which could make it harder for many people to access healthcare.
The US also has a “fragmented” health system, the study authors said, with a mix of job-sponsored, privately purchased, and government-run health coverage. Millions of Americans don’t have health insurance at all.
That means that even though they can sign up for public health insurance when they turn 65, guaranteed health coverage in old age isn’t enough to make up for any gaps earlier in life.
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“A low socioeconomic status is a well-known risk factor” for heart health issues, Dr Filippo Crea, editor-in-chief of the European Heart Journal, told Euronews Health.
Access to care appears to drive outcomes
Previous research has shown that uninsured Americans are less likely to get medical care for high blood pressure and high cholesterol.
Meanwhile, Denmark has a universal healthcare system for citizens, with few out-of-pocket costs.
“Everybody has the same access to the healthcare system,” said Gislason, who is also chief science officer at the Danish Heart Association.
The issues are “connected because when you have wide access to the healthcare system, you have low cost of medications, so it doesn't depend on your income or education or employment status that you have access to professional care”.
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Cardiovascular disease costs Denmark about €343 per capita annually, which is on par with other European Union countries.
Notably, older Americans are also more likely than Danes to have high blood pressure, high cholesterol, and diabetes, which are all risk factors for heart disease.
And while the US had higher hospitalisation rates for heart failure and heart attacks, it had a lower rate than Denmark when it came to ischemic stroke.
Gislason said that could be because Danes with less severe heart problems are usually treated in an outpatient clinic, while the threshold for hospitalisation may be lower in the US.
Meanwhile Crea said Danes may be more aware of stroke symptoms and thus more likely to seek medical advice.
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“It might reflect a public health system which works better,” said Crea, who was not involved with the new study.
Denmark’s system arguably still has flaws. While income-related disparities in hospitalisations were narrower than in the US, they persisted.
Overall, high-income Danes had a cardiovascular hospitalisation rate of 13 per 10,000 compared with 18.8 among their lower-income peers, the study found.
The researchers said the findings underscore the need for “targeted public health and policy efforts to improve the cardiovascular health of socially vulnerable populations in both countries”.
