Educational inequalities in self-rated health across US states and European countries

Objectives: The US shows a distinct health disadvantage when compared to other high-income nations. A potential lever to reduce this disadvantage is to improve the health situation of lower socioeconomic groups. Our objective is to explore how the considerable within-US variation in health inequalities compares to the health inequalities across other Western countries. Methods: Representative survey data from 44 European countries and the US federal states were obtained from the fourth wave of the European Values Study (EVS) and the 2008 wave of the Behavioral Risk Factor Surveillance System. Using binary logistic regression, we analyze different forms of educational inequalities in self-rated health (SRH), adjusted for age and sex. Results: The extent of educational inequalities in SRH varies considerably over European countries and US states; with US states in general showing greater inequality, however, differences between US states and European countries are less clear than commonly assumed. Conclusions: The US has considerable differences in educational inequalities in SRH across geographic locations. To understand the reasons for the US health disadvantage, comparative research has to take into account the vast variation in health inequalities within the US.