All-cause mortality is increased for older adults with sudden loss of wealth in the US

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. In the US, about a quarter of adults over the age of 50 suffer from a significant loss of wealth over less than two years.

2. Adults who lose a significant fraction of their wealth in this short period are at higher risk of all-cause mortality.

Evidence Rating: 2 (Good)

Study Rundown: Evidence has shown that people with lower socioeconomic status have substantially poorer health outcomes. For older adults, a sudden loss of wealth can represent a significant permanent change in economic status, though it is unknown how this sudden ‘wealth shock' can affect overall health.  In this study, it was determined that about a quarter of older adults in the US experienced a negative wealth shock, as defined by a loss of over 75% of their net worth over two years. For those who experienced a wealth shock, all-cause mortality was greatly increased, and loss of a primary residence with wealth shock exacerbated the increased mortality rate. Sex, ethnicity, and baseline net worth did not significantly influence the association of wealth shock and increased mortality.

This study found a clear association between wealth shock towards the end of life and increased mortality, further suggesting that socioeconomic status greatly affects health. While this association seems robust, future studies will be needed to determine how wealth shock leads to increased mortality, with hypotheses concerning decrease in health care spending and increased psychosocial stress needing testing. Along this line, it is unknown if macroeconomic trends, such as the 2008 Great Recession, influenced the association between wealth shock and mortality. Further, with the Affordable Care Act in place, it is unclear if the mortality rate would be as highly increased with wealth shock, as greater systemic protections would be in place for these patients.

Click to read the study, published in JAMA

Relevant Reading: Socioeconomic Factors, Health Behaviors, and Mortality

In-Depth [prospective cohort study]: A total of 8714 U.S adults, aged 51 or over, were followed for a mean of 17.7 years from 1994 to 2014 as part of the Health and Retirement Study (HRS). Of these, 2430 (26%) experienced a negative wealth shock and another 749 (6%) had long-term asset poverty. A total of 2923 participants died during follow-up. For those who experienced a negative wealth stock, their all-cause mortality rate was 64.9 per 1000-person years (HR 1.50, CI95 1.36-1.67) compared to 30.6 per 1000-person years for those with positive wealth without shock and 73.4 per 1000-person years for those with asset poverty (HR 1.67, CI95 1.44-1.94). All-cause mortality was more pronounced for participants who had a negative wealth shock and loss of their primary residence (HR 1.87, 95% CI 1.58-2.21). There was no interaction between sex, ethnicity, nor baseline category of net worth in terms of wealth shock and increased mortality.

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