The US population lives fewer years on average than the European population, and the differences in mortality by wealth are greater. These results are attributed to the fact that the two populations have different health care and social support systems, which are generally more developed in European countries.
It is well known that mortality rates are directly related to wealth, i.e. rich people live longer than poor people. This reality can be observed within each country, but also when countries are compared with each other. In recent decades, inequality in the distribution of wealth has increased in most countries, although in the United States (US) the differences are more pronounced than in Europe, and at the same time there has been a decline in life expectancy.
In a study published in the New England Journal of Medicine, American and British researchers examined the relationship between wealth and mortality among the elderly in order to find out whether the decline in life expectancy in the US is common to all social groups, both the richest and the poorest.
To do this, they conducted a retrospective study using data from 2010 to 2022 on people aged between 50 and 85, taken from databases derived from surveys that allowed comparisons to be made between the US and Europe. Given the heterogeneity of European countries, they were grouped into three categories: 1. North and West (Austria, Belgium, Denmark, France, Germany, the Netherlands, Sweden and Switzerland); 2. South (Italy, Portugal and Spain) and 3. East (Czech Republic, Estonia, Hungary, Poland and Slovenia). The USA was divided into four regions: Northeast, Midwest, South and West. The main variables were wealth distribution (measured in terms of property, inheritance, savings, etc.) and all-cause mortality in a sample of 73,838 participants in the selected age group.
As expected, there were significant differences in the distribution of assets among participants in the US study, ranging from £21,600 in the South to £75,500 in the Midwest. Inequalities were also observed in Europe, with participants in Poland having the least resources at £800 and those in Switzerland having the most at £157,400. Over the ten years observed, initial wealth increased in the US and decreased in Europe.
In terms of mortality, 18.7% of participants died over the same period, a rate of 4.8 deaths per 1,000 people per year. The distribution by region was very different: the lowest mortality rates were observed in Northern and Western Europe (2.9/1,000) and the highest in the United States (7.2/1,000). When participants from both continents were divided into four groups according to wealth, survival was lower in the poorest quartile and higher in the richest quartile in all areas.
And everywhere, survival was higher as wealth increased, but it was lower for participants aged 50 to 59 than for older participants. And everywhere, survival was higher as wealth increased, but it was lower for participants aged 50 to 59 than for older participants. Overall, the richest group of people were 40% less likely to die than the poorest over the period observed.
Comparing data from the US and Europe reveals some very relevant information:
● Mortality among the wealthiest Americans was higher than that of most Northern and Western Europeans and that of the wealthiest Southern Europeans.
● Mortality among the wealthiest Americans was similar to that of the poorest Northern and Western Europeans, as well as that of most Eastern Europeans.
● The poorest Americans had the lowest survival rates of any group in the study sample and died disproportionately earlier than their European counterparts.
● The United States also had the largest differences in mortality between the richest and the poorest.
In short, in the age group studied, the US population, as a whole, lives fewer years than the European population, and the differences in mortality associated with wealth are greater. These results can be attributed to the fact that the two populations have different health care and social support systems, which are generally more developed in European countries. Limited access to health care or education and weak social support structures among the most disadvantaged sectors of the US population could explain their lower survival rates.
However, this would not be the case for people of higher economic status who have access to greater resources, in particular a health care system that can be considered one of the best in the world from a technological point of view. The authors point to other factors inherent to American society, which affect all social classes, that could explain the high mortality rates compared with the European countries included in the study. These factors include diet, environmental quality, social, cultural and behavioural attitudes (risky behaviour, violence, drug abuse, etc.), which affect the whole of society, although the poor are more vulnerable to these systemic factors.
In fact, this confirms what the social determinants of health models say. Dahlgren and Whitehead, who in the 1990s extended the conceptual model formulated by Lalonde twenty years earlier, graphically depicted the various social components that determine health in a concentric layers, with cultural and environmental conditions at the top level, which, to the extent that they are systemic in nature, affect all social groups.
The economic and political dynamics of recent years may lead to greater inequalities and a progressive weakening of public services, leaving the provision of people’s health and social needs to market forces, leading to greater poverty and social exclusion. Unfortunately, this is likely to result in higher rates of disease and mortality.
