Association between wealth and mortality in the United States and Europe

Machado, Sara ORCID: 0000-0002-9287-8165, Kyriopoulos, Ilias ORCID: 0000-0002-3932-8228, Orav, E. John and Papanicolas, Irene ORCID: 0000-0002-8000-3185 (2025) Association between wealth and mortality in the United States and Europe. New England Journal of Medicine, 392 (13). pp. 1310-1319. ISSN 0028-4793

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Abstract

BACKGROUND Amid growing wealth disparity, we have little information on how health among older Americans compares with that among older Europeans across the distribution of wealth. METHODS We performed a longitudinal, retrospective cohort study involving adults 50 to 85 years of age who were included in the Health and Retirement Study and the Survey of Health, Ageing, and Retirement in Europe between 2010 and 2022. Wealth quartiles were defined according to age group and country, with quartile 1 comprising the poorest participants and quartile 4 the wealthiest. Mortality and Kaplan–Meier curves were estimated for each wealth quartile across the United States and 16 countries in northern and western, southern, and eastern Europe. We used Cox proportional-hazards models that included adjustment for baseline covariates (age group, sex, marital status [ever or never married], educational level [any or no college education], residence [rural or nonrural], current smoking status [smoking or nonsmoking], and absence or presence of a previously diagnosed long-term condition) to quantify the association between wealth quartile and all-cause mortality from 2010 through 2022 (the primary outcome). RESULTS Among 73,838 adults (mean [±SD] age, 65±9.8 years), a total of 13,802 (18.7%) died during a median follow-up of 10 years. Across all participants, greater wealth was associated with lower mortality, with adjusted hazard ratios for death (quartile 2, 3, or 4 vs. quartile 1) of 0.80 (95% confidence interval [CI], 0.76 to 0.83), 0.68 (95% CI, 0.65 to 0.71), and 0.60 (95% CI, 0.57 to 0.63), respectively. The gap in survival between the top and bottom wealth quartiles was wider in the United States than in Europe. Survival among the participants in the top wealth quartiles in northern and western Europe and southern Europe appeared to be higher than that among the wealthiest Americans. Survival in the wealthiest U.S. quartile appeared to be similar to that in the poorest quartile in northern and western Europe. CONCLUSIONS In cohort studies conducted in the United States and Europe, greater wealth was associated with lower mortality, and the association between wealth and mortality appeared to be more pronounced in the United States than in Europe.

Item Type:	Article
Additional Information:	© 2025 Massachusetts Medical Society
Divisions:	LSE Health Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited:	14 Apr 2025 10:30
Last Modified:	15 Apr 2025 08:30
URI:	http://eprints.lse.ac.uk/id/eprint/127894

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