(May 2025) Wealthy Americans have about the same odds of survival as the poorest Europeans in developed countries, according to a published in the New England Journal of Medicine by researchers from Brown University, the London School of Economics, and Harvard, led by Dr. Irene Papanicolas.

They tracked over 73,000 adults aged 50 to 85 in the U.S. and 16 European countries for about ten years. European participants were followed through the Survey of Health, Ageing and Retirement in Europe (SHARE), while U.S. participants came from our sister study, the Health and Retirement Study (HRS).

The Link Between Wealth and Lifespan

It’s well known that wealth tends to be linked to longer life. But this research shows that where you live matters just as much—if not more—than how rich you are.

Researchers divided people into four wealth groups in each country, from the poorest 25% (group 1) to the wealthiest 25% (group 4). This approach is important because the researchers didn't use the same dollar amount to define "wealthy" across countries. Someone considered "wealthy" in one country might be considered "middle class" in another due to different costs of living and economic conditions. Instead, they looked at relative wealth within each country. They then tracked who died over the next decade while accounting for factors like age, gender, education, smoking habits, and existing health conditions.

Over the 10-year follow-up, nearly 1 in 5 participants died. But your risk of dying wasn’t the same everywhere—it depended not just on your wealth, but how your country supports people at different wealth levels.

It's no surprise that having more money generally means living longer - this pattern showed up consistently across all countries studied. But the gap between rich and poor was dramatically wider in the United States, revealing a troubling reality about the American health experience.

Wealth Alone Can’t Guarantee Longevity in America

Across all countries, wealthier people lived longer. Compared to the poorest group:

• The second poorest had a 20% lower risk of dying.
• The second wealthiest had a 32% lower risk.
• The wealthiest had a 40% lower risk of death.

But despite this - the wealthiest Americans had roughly the same survival rates as the poorest people in Northern and Western Europe. In other words, being rich in America offers about the same longevity as being poor in countries like Denmark or France.

Why Do Europeans Live Longer, Even with Less Money?

What might explain these startling differences? While the study doesn't provide definitive answers, several factors likely contribute:

1. Healthcare access: Most European countries have universal healthcare systems that provide care regardless of wealth, while Americans often face financial barriers to healthcare.
2. Stronger safety nets: Social protections—like unemployment benefits, housing support, and pensions—are more robust in Europe.
3. Better work-life balance: Paid holiday, sick leave, and shorter working hours help reduce stress and burnout.
4. Walkable cities: European cities often feature more walkable neighbourhoods and better public transportation, making active lifestyles easier to maintain.
5. Lower inequality: Societies with smaller income gaps tend to have better overall health, and the U.S. has some of the highest inequality among rich nations.

Why it Matters

This study challenges the idea that individual wealth is enough to protect you from poor health outcomes. It suggests that the design of our societies—healthcare, social policy, inequality—matters just as much.

For Americans, the study suggests that addressing economic inequality might be one of the most powerful public health interventions possible. And for policymakers, it highlights an urgent need to rethink the systems that shape health, beyond just personal choices or medical care.

Study by Machado, S., Kyriopoulos, I., Orav, E., & Papanicolas, I. (2025): Association between Wealth and Mortality in the United States and Europe. The New England Journal of Medicine, 392(13). DOI: 10.1056/NEJMsa2408259

URL: https://www.nejm.org/doi/full/10.1056/NEJMsa2408259

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