Middle-aged, white Americans are much sicker than their counterparts in England, startling new research shows, despite U.S. health care spending per person that is more than double what England spends.

A higher rate of Americans tested positive for diabetes and heart disease than the English. Americans also self-reported more diabetes, heart attacks, strokes, lung disease and cancer.

The gap between countries holds true for educated and uneducated, rich and poor.

"At every point in the social hierarchy there is more illness in the United States than in England and the differences are really dramatic," said study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.

The study, appearing in Wednesday's Journal of the American Medical Association, adds context to the already-known fact that the United States spends more on health care than any other industrialized nation, yet trails in rankings of life expectancy.

The United States spends about $5,200 per person on health care while England spends about half that in adjusted dollars.

"Everybody should be discussing it: Why isn't the richest country in the world the healthiest country in the world?" Marmot said.

The researchers looked for answers in the data, which came from government-sponsored health surveys. The research was supported by grants from government agencies in both countries.

Smoking rates are about the same on both sides of the pond. The English have a higher rate of heavy drinking, but a higher percentage of Americans are obese.

The researchers crunched numbers to create a hypothetical statistical world in which the English had Americans' lifestyle risk factors. In that model, in which the English were as fat as the Americans, the researchers found Americans still would be sicker.

Only non-Hispanic whites were included in the study to eliminate the influence of racial disparities. The researchers looked only at people ages 55 through 64, and the average age of the samples was the same.

Americans reported twice as much diabetes as the English: 12.5 percent vs. 6 percent. High blood pressure was reported by 42 percent of Americans and 34 percent of English. Cancer showed up in 9.5 percent of Americans and 5.5 percent of the English.

The upper crust in both countries were healthier than middle-class and low-income people in the same country. But richer Americans' health status resembled the health of the low-income English.

Health experts have known the United States population is less healthy than that of other industrialized nations, according to several important measurements. For example, U.S. life expectancy ranks behind that of about two dozen other countries, according to World Health Organization statistics.

Some believe the U.S. has lagged because it has a more ethnically diverse population than some of the higher-ranking countries, like Iceland and Sweden, said Richard Suzman of the U.S. National Institutes of Health.

"Minority health in general is worse than white health," said Suzman, summarizing the theory.

But the new study showed that when minorities are removed from the equation, and adjustments are made to control for education and income, white people in England are still healthier than white people in the United States.

"As far as I know, this is the first study showing this," said Suzman, who is director of the NIH's National Institute on Aging's Behavioral and Social Research Program.

NIH provided some of the funding for the new study. Suzman called the results "surprising."

"Why? It's something of a mystery," Suzman said.

One possible explanation may be the United States has been going through an obesity epidemic that only just recently has begun impacting the United Kingdom. Because the most recent data in the study is at least three years old, the disparity in the two nations' obesity problems may seem especially pronounced, he said.

Marmot offered an explanation for the gap: Americans' financial insecurity. Improvements in household income have eluded all but the top 20 percent of Americans since the mid-1970s. Meanwhile, the English saw their incomes improve, he said.

Robert Blendon, professor of health policy at the Harvard School of Public Health, said the stress of striving for the American dream may account for Americans' lousy health. He was not involved in the study.

"The opportunity to go both up and down the socioeconomic scale in America may create stress," Blendon said. Americans have more chances to both succeed and fail. They do not have a reliable government safety net like the English enjoy, Blendon said.

Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed.

Both said it might explain better health for low-income citizens, but can't account for better health of Britain's more affluent residents.

Marmot cautioned against looking for explanations in the two countries' health-care systems.

"It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said.