NEJM: Association between Wealth and Mortality in the US and Europe

#1

No real surprises here, the wealthier you are, the longer your lifespan. The interesting part for me is that surviival in the wealthest quartile of US citizens is apparently the same as the poorer Europeans (see last sentence).

Association between Wealth and Mortality in the United States and Europe

Authors: Sara Machado, Ph.D. ORCID, Ilias Kyriopoulos, Ph.D., E. John Orav, Ph.D., and Irene Papanicolas, Ph.D.Author Info & Affiliations

Published April 2, 2025

N Engl J Med 2025;392:1310-1319

DOI: 10.1056/NEJMsa2408259

[VOL. 392 NO. 13]

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.

#2

I guess in Bryan Johnson’s protocol “Don’t Die” should be right after “Don’t be poor”.

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#3

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This image shows it best…

#4

Best anti-aging therapy is not rapamycin, it’s accumulating wealth.

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#5

Don’t you agree that it’s actually the opposite point that is the interesting nuance:

The interesting part for me is that surviival in the wealthest quartile of US citizens is apparently the same as the poorer Europeans (see last sentence). @WJ_PhD

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#6

I scanned it too quickly and missed that - good point.

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#7

I"m kinda casting about for reasons why…my best 2 educated guesses are that the US healthcare system is not as good (even for the wealthiest quartile most of them are in traditional HMOs) so if you do get seriously ill, you are more likely to die in the US. The 2nd reason is that the average BMI and obesity rates of US people is greater than their European counterparts.

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#8

A bit concerning that money was spent funding this study.

#9

Who here is moving to northern or western Europe to add a guaranteed five years to their lifespan?

And for those of you that aren’t, tf is the matter with you??? Name one other intervention that comes anywhere close to doing that.

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#10

IMO it’s more useful than a lot of things that get studied. After all, you need to know the status quo before you can make any sort of decisions. And the implications of this are actually huge. Imagine the economic gains which are being squandered due to Americans’ uniquely poor health and short lifespans.

I disagree. If you need the best of the best, it’s probably in the USA. It’s where the majority of the best drugs and advanced therapeutics are invented, and the newest surgical techniques. It’s where celebrities and politicians and other VIPs go when they need help.

In reality, there’s a mixture of factors like the food environment, stress and culture. The last one is really significant IMO; vehicular deaths are high in the USA. Suicide rates are high (again, a factor of culture, stress, mental health, and access to easy methods to kill oneself). Drug abuse rates and accidental overdoses are also pretty high compared to other wealthy countries. Even for obesity, sure America is fat, but that itself is mostly a symptom of the environment and culture; abundance of easy and addictive junk food, lack of regulations on ingredients and portion sizes (Americans don’t like government telling them what to do).

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#11

I was wondering if cortisol was an issue with life in the USA being more stressful so I asked chatGPT which didn’t give a definitive answer:

are cortisol levels in the USA higher than other countries

ChatGPT said:

There is no definitive large-scale study proving that cortisol levels are consistently higher in the USA than in other countries, but some research and indirect evidence suggest they might be, on average, due to the following:

Factors that may contribute to higher cortisol levels in the U.S.:

  1. Work stress and culture: The U.S. is known for long working hours, fewer vacation days, and a “hustle” culture, all associated with chronic stress and elevated cortisol.
  2. Sleep deprivation: Americans often get less sleep than people in many other developed countries, and poor sleep is a strong driver of high cortisol.
  3. Diet: High intake of sugar, caffeine, and ultra-processed foods—common in the U.S.—can contribute to elevated cortisol.
  4. Social and economic pressures: Healthcare access, student loan debt, income inequality, and job insecurity are more intense in the U.S. compared to some European countries, adding to baseline stress levels.
  5. Less social safety net: Countries with stronger public support systems (e.g., Scandinavian nations) tend to have lower average stress levels, which may correlate with lower cortisol.

What does the research say?

  • Cross-cultural studies on cortisol are limited**. Most comparisons are small-scale and often focus on stress responses rather than baseline levels.
  • Some studies suggest higher stress levels (as measured by surveys and subjective reports) in the U.S. compared to countries like Sweden, Germany, or Japan, but these don’t always directly measure cortisol.

In short, while there’s no conclusive proof that cortisol levels in the U.S. are higher, the environment and lifestyle factors in the U.S. strongly suggest a higher likelihood of elevated average cortisol compared to countries with less stress-inducing environments.

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#12

I think you need to be more specific… Higher than what countries? Higher than in Israel and the Gaza strip probably not. Higher than china? Probably not. Higher than Finland and Sweden… ? Probably.

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#13

Just pointing out that in the sulfurophane post I argued that if the stuff really worked, you’d see longer life expectancy in areas that ate a lot of Kale. Those areas happen to be in Northern and Western Europe.

Not to say that RFK Jr might not be onto something about petrochemical based food colorings in the US food supply.

This study suggests, strongly, that we need more information.

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#14

My point was not that it’s more useful. It’s not worth the money. Nor are all the other studies you’ve implying. I know the status quo without wasting money.

#15

Sorry, how exactly would you know the obesity rate and life expectancy without researching it?

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#16

Attia was interviewing a Healthcare exec, and he pointed out that the Healthcare system in the US is very good for people over 65, and it’s the best in the world by that metric . Where it fails is obviously in the 20-50 range where obesity, atherosclerosis, addiction arw ravaging the population. So if you’re lucky enough to make it to 65 here, you’re golden!

#17

Do we have any research we can audit on that basis?

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#18

If best = most expensive, then yes, America’s health system is the best.

In all honesty, comparing Hong Kong health system to America’s, they are on par in terms of medicine. Hong Kong doesn’t have a lot of surgical robots and the niftiest equipment though. I’d say they’re behind on that.

But Hong Kongers get their healthcare for free without the need for insurance.

#19

What I’ve noticed is that all kinds of high-tech and progressive treatments are available in the US if you have the money to pay for them, and I’m glad that the bleeding edge is being financed by those who can afford these treatments. Sadly, average Americans do not know that these treatments exist, and even if they did, they could not afford them. Health care available to lower-income citizens in the US seems to be much poorer than what is available in Western countries with socialized medicine. In countries like Canada, you will not get a whole body MRI paid for by the government, but you will get a free colonoscopy, and your GP will nag you about getting one until you submit.

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#20

I realize that it seems you’re only here to disagree with people, but it’s rather obvious that having some money allows you to have shelter, eat well, exercise, and get good health care and thus live longer.

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