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Americans are much sicker than people living in other high-income countries, according to a new study from the Commonwealth Fund.

Showing the highest rate of 11 countries surveyed, 28 percent of American adults said they have two or more chronic illnesses such as arthritis, diabetes or high blood pressure. Twenty-six percent said they experienced emotional distress they couldn’t cope with by themselves, according to a report in Modern Healthcare.

At 22%, Canada showed the second highest rate of chronic conditions, but the highest rate of emotional distress at 27%. In each of the countries surveyed, at least 14% of adults reported having multiple chronic conditions.

Americans are also more likely than others to go without recommended healthcare, fail to fill a prescription or avoid the doctor when sick because of costs. About a third of U.S. adults said they skipped needed healthcare because they couldn’t afford it, down from 37% in the last 2013 survey. Additionally, adults in the U.S. still report greater financial barriers to accessing care than the 10 other countries surveyed.

Other nations surveyed included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

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