October 24, 2017
2 min read

Low wealth heightens risk for death, disability in US, England

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In the United States and England, individuals in the lowest quintile of wealth were significantly more likely to die or be disabled than those in the highest quintile of wealth, according to findings published in JAMA Internal Medicine.

Low income has been associated with poor health outcomes,” Lena K. Makaroun, MD, from VA Puget Sound Health Care System, and colleagues wrote. “Owing to retirement, wealth may be a better marker of financial resources among older adults.”

Makaroun and colleagues used data from the 2002 waves of the U.S. Health and Retirement Study (HRS; n = 12,173; 54% women) and English Longitudinal Study of Aging (ELSA; n = 7,599; 52% women) to assess the wealth-mortality and wealth-disability relationships in older adults from the United States and England. The researchers stratified analyses by age (54 to 64 years vs. 66 to 76 years). Follow-up assessing mortality and disability was completed in 2012.

In the younger cohort, there were 6,233 respondents from the United States and 4,325 respondents from England; in the older cohort, there were 5,940 respondents from the United States and 3,274 respondents from England. Nonwhite participants were more common in the HRS than ELSA in the younger (14% vs. 3%) and older (13% vs. 3%) cohorts.

Results showed that as wealth declined, the risk for death and disability rose in both the United States and England. This association was observed across all ages studied, starting at age 54 years and continuing into later life.

In the United States, there was a 17% risk for mortality (HR = 3.3; 95% CI, 2-5.6) and 48% risk for disability (subHR = 4; 95% CI, 2.9-5.6) over 10 years for participants in the younger cohort and the lowest wealth quintile ( $39,000), compared with a 5% risk for mortality and 15% risk for disability among those in the highest wealth quintile (> $560,000).

In England, there was a 16% risk for mortality (HR = 4.4; 95% CI, 2.7-7) and 42% risk for disability (subHR = 3; 95% CI, 2.1-4.2) over 10 years for participants in the younger cohort and the lowest wealth quintile ( £34,000), compared with a 4% risk for mortality and 17% risk for disability for those in the highest wealth quintile (> £310,550).

There were greater absolute risks for mortality and disability in the older cohort; however, risks were similar across wealth quintiles. The HR for mortality and sub HR for disability weakened, but stayed significant after adjustment for sex, age, race, income and education.


“This study found no evidence that providing state-sponsored health insurance from birth (England), or providing state-sponsored health insurance later in life (United States), eliminated wealth-associated health disparities,” Makaroun and colleagues concluded. “Our study suggests that policy makers interested in decreasing mortality and function disparities in older adults should take a broad view and consider interventions beyond providing access to health care.”

In an accompanying editorial, Martin McKee, MD, DSc, from the London School of Hygiene and Tropical Medicine, and David Stuckler, PhD, from Bocconi University, Milano, Italy, wrote that this study offers a new perspective in investigating how wealth differences affect health outcomes and their results are “alarming and surprising.”

Studying wealth-related inequalities is challenging because obtaining comparable data requires “detailed questioning about matters that may be extremely sensitive,” according to McKee and Stuckler. Furthermore, they argue that valuing assets and reaching the very wealthy in surveys can be difficult.

“Makaroun and colleagues were not able to overcome all these challenges, but they have gone far beyond earlier attempts and deserve congratulations for doing so,” they concluded. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.