Richest Americans have lower life expectancy than Europeans

In a city like Madrid, men live, on average, three years longer in the Chamartín neighborhood, with greater purchasing power, than in Puente de Vallecas, a working-class area. The trend is similar worldwide, because economic capacity correlates with health and life expectancy. However, according to a recent publication in The New England Journal of Medicine, this dynamic changes when comparing the rich and poor in the U.S. and Europe.

The study, led by Irene Papanicolas, a professor of health services at the Brown School of Public Health, sampled 73,000 Americans and Europeans aged between 50 and 85. They were followed since 2010 to observe the effect of wealth on an individual’s likelihood of dying. First, it was found that, in both the U.S. and Europe, the rich lived longer than the poor, although the gap was much greater in the United States.

This finding was consistent with previous studies showing that the wealthy live longer, but when the comparison was made across continents, the result was even more surprising. Mortality rates across all wealth levels in the U.S. were higher than in the European regions included in the study. The wealthiest Americans had a lower life expectancy than the wealthiest Europeans, and did not exceed that of the poorest in some European countries such as Germany, France, and the Netherlands.

In a statement from her institution, Sara Machado, a researcher at Brown University and co-author of the study, argues that her findings are a humbling experience for the United States and a call to action for policymakers who can improve national health. “If you look at other countries, they have better results, and that means we can learn from them and improve,” she says. “It’s not about spending more; it’s about addressing the factors we’re overlooking that could give us greater benefits than we think.”

According to the study, the richest 25% of individuals had a 40% lower mortality rate than those in the poorest quartile. Furthermore, European participants died at approximately 40% lower rates than those in the United States throughout the study period. In Southern Europe, estimated mortality rates were 30% lower than those of American participants, while in Eastern Europe, mortality rates were between 13% and 20% lower compared to the U.S.

It seems that there are very wealthy people who do not have access to a healthcare system as comprehensive as Europe’s”

Miguel Ángel Martínez Beneito, lead author of the National Mortality Atlas in Spain

These data provide further insight into why, in recent years, life expectancy in the world’s most powerful country, where the planet’s greatest scientific and medical breakthroughs emerge, has been declining.

Papanicolas acknowledges that “there are many differences we observed between the United States and Europe, but it’s not clear how they explain the health advantages of Europeans over Americans.” The study found that many of the determinants associated with longer survival, such as having a college education, not smoking, or being married, are more concentrated among the wealthiest 25% of Americans, which would explain the large gap in life expectancy between rich and poor in that country. In Europe, factors such as education and smoking are more evenly distributed.

“Wealth can influence health by affecting access to education, job opportunities, healthcare, and social networks, all important predictors of health,” the researcher notes. “Possibly, the more generous social safety net in Europe also exerts a protective effect on the survival of those with fewer resources, and wealth status matters less overall,” she adds. “This finding tells us that, although wealth is linked to health everywhere, in Europe, especially in the north and west, less wealth is needed to achieve better life expectancy than in the United States.”

For the researchers, their results serve as a reminder that even the wealthiest Americans are not protected from the country’s structural problems, which are influencing worsening health and reducing life expectancy, such as economic inequality, stress, poor nutrition, and environmental risks. “If we want to improve health in the U.S., we need to better understand the underlying factors that contribute to these disparities, especially among similar socioeconomic groups, and why they translate into different health outcomes across countries,” Papanicolas says.

Miguel Ángel Martínez Beneito, lead author of the National Mortality Atlas in Spain, highlights that the most striking aspect of the work published Wednesday in The New England Journal of Medicine is the transversality of mortality in the U.S. across all economic groups. “This means that this excess mortality goes beyond economic issues, because it seems that there are very wealthy people who do not have access to a healthcare system as comprehensive as Europe’s, or who are exposed to higher cumulative risk factors than Europeans,” he points out. “Now we must open lines of research to determine what factors explain the data, and how to improve access to a healthier life for all of American society.”

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