Even rich Americans live shorter lives than poor Europeans, study finds

By Priyanjana Pramanik, MSc.Reviewed by Susha Cheriyedath, M.Sc.Apr 7 2025

A major international study finds that even the wealthiest Americans don’t live as long as their European peers—raising tough questions about inequality, healthcare, and policy failure in the U.S.

Study: Association between Wealth and Mortality in the United States and Europe. Image Credit: Khongtham / Shutterstock

In a recent study published in the journal The New England Journal of Medicine, researchers examined the relationship between wealth and mortality among individuals aged 50 to 85 in Europe and the United States.

They found that having more wealth was associated with lower mortality in both regions; however, the survival gap between the wealthiest and poorest individuals was greater in the U.S. compared to Europe. Wealthy Europeans had better survival rates than wealthy Americans.

Importantly, the wealthiest Americans had survival rates similar to the poorest individuals in northern and western Europe, indicating systemic disadvantages across the U.S. population.

Background

Over the past six decades, the United States has experienced a significant rise in wealth inequality, as resources have shifted from middle-class households to the wealthiest Americans. While other high-income nations have also seen rising inequality, this has been to a lesser degree.

At the same time, life expectancy for Americans has fallen below that of other wealthy nations and continues to decline, particularly among poorer groups. Wealth, defined as the total resources and assets that an individual controls, is crucial for health in older age.

Unlike income, which can be redistributed through taxation, wealth inequality is more challenging to correct and tends to persist across generations. Wealth becomes especially important after retirement, influencing access to long-term care, healthcare, and social support.

Comparing the associations between health and wealth outcomes in the U.S. and Europe, where social support and healthcare systems differ, may reveal whether America’s poorer life expectancy is due to wider disparities or consistently increased mortality for all groups.

In addition, the study focused on relative wealth within countries rather than absolute wealth, which allowed researchers to assess how an individual's standing within their national wealth distribution relates to survival.

About the Study

In this study, the researchers used data from 2010 to 2022 to investigate how wealth correlates with mortality in older adults across 16 European countries and the U.S. They utilized data from two large surveys: the Health and Retirement Study (HRS) in the U.S. and the Survey of Health, Ageing, and Retirement in Europe (SHARE).

Both surveys collect detailed information on health, wealth, education, residence, and demographics for adults aged 50 and older. The researchers included participants who were aged 50–85 at baseline in 2010 and followed them until 2022. Proxy interviews were conducted to collect information from participants who had passed away.

To account for regional differences, Europe was divided into three groups: Eastern Europe, Southern Europe, and Northern and Western Europe. Total non-housing assets measured wealth, and participants were categorized into wealth quartiles based on age group and country. The primary outcome measured was mortality from all causes between 2010 and 2022, with death rates calculated in thousands of person-years.

The team adjusted their analyses for several factors measured at the start of the study: age group, marital status, sex, education (whether any college education was received or not), rural versus non-rural residence, smoking status (current smoker or nonsmoker), and the presence of long-term health conditions.

Mortality risks were assessed using Kaplan–Meier survival curves and Cox proportional-hazards models to quantify the relationship between mortality and wealth. American mortality patterns were also analyzed by Census region (Northeast, Midwest, South, West).

They also assessed how the relationship between wealth and mortality changed over time at 2, 5, and 8 years of follow-up, and how this association varied across age groups.

Findings

The research team analyzed data from 73,838 participants aged 50–85 across the United States and 16 European countries, with a median follow-up of 10 years. Participants in northern and western Europe had higher levels of education and wealth compared to those in southern and eastern Europe, as well as in the United States.

The median wealth was highest in Switzerland (€157,400) and lowest in Poland (€800), while in the U.S., it varied widely across regions. Overall, 18.7% of participants died during the study period, with mortality rates ranging from 2.9 per 1000 person-years in northern and western Europe to 6.5 per 1000 person-years in the United States.

Wealth was strongly associated with survival: participants in higher wealth quartiles had significantly lower risks of death compared to those in the poorest quartile. The poorest American participants had worse survival rates than even the poorest Europeans.

The survival disparity by wealth was greatest among those aged 50 to 59 years, and diminished in older age groups, suggesting that the protective effect of wealth is more pronounced in earlier old age.

Regional gaps within the United States were notable, with the Midwest and South exhibiting the greatest disparities in survival by wealth. Adjusted hazard ratios showed that wealthier participants had substantially lower mortality risks.

Europeans, particularly those from northern and western Europe, consistently showed lower mortality rates than their counterparts in the United States over two, five, and eight years of follow-up.

The researchers observed a stronger 'survivor effect' in the U.S., where poorer individuals died disproportionately earlier, skewing the older population toward higher wealth levels.

Conclusions

This study highlights a strong link between wealth and survival among older adults across the U.S. and Europe, with poorer Americans facing particularly high mortality rates. The wealthiest Americans had survival rates similar to those of the poorest in northern and western Europe. Wealth-related survival gaps were evident, especially in the U.S. Midwest and South.

Although the study reported differences in hazard ratios over time intervals, it did not explicitly conclude that survival gaps widened over time.

These findings challenge the assumption that wealthy Americans enjoy equal or superior health outcomes compared to their European peers and suggest that systemic disadvantages affect even the most privileged socioeconomic groups in the U.S.

Limitations of this study include potential differences in wealth reporting, healthcare access, and unmeasured confounders between countries. Further study is needed to explore the mechanisms linking wealth and mortality, including healthcare quality, social policies, and lifestyle factors, in order to better understand cross-national differences and inform interventions aimed at reducing health inequalities.

The study also lacked racial and ethnic data, limiting the ability to assess how disparities in wealth and health intersect among minority populations in the U.S.

The authors emphasize that while weaker social structures may explain some disparities, additional factors such as behavioral, cultural, and environmental influences may play a role in shaping health outcomes across all wealth strata.