PROVIDENCE, R.I. [Brown University] — Comparing wealth and survival rates in the U.S. with those in Europe, researchers found that over a 10-year period, Americans across all wealth levels were more likely to die than their European counterparts.
The findings were detailed in a new study in the New England Journal of Medicine by a team led by researchers at the Brown University School of Public Health.
The analysis compared data from more than 73,000 adults in the U.S. and different regions of Europe who were age 50 to 85 in 2010 to determine how wealth affects a person’s chances of dying. The results revealed that people with more wealth tend to live longer than those with less wealth, especially in the U.S., where the gap between the rich and poor is much larger than in Europe.
Comparison data also showed that at every wealth level in the U.S., mortality rates were higher than those in the parts of Europe the researchers studied. The nation’s wealthiest Americans have shorter lifespans on average than the wealthiest Europeans; in some cases, the wealthiest Americans have survival rates on par with the poorest Europeans in western parts of Europe such as Germany, France and the Netherlands.
U.S. life expectancy has been declining in recent years, said study author Irene Papanicolas, a professor of health services, policy and practice at Brown. The study provides a more detailed picture of life expectancy across demographics in the U.S. compared to different parts of Europe, she said.
“The findings are a stark reminder that even the wealthiest Americans are not shielded from the systemic issues in the U.S. contributing to lower life expectancy, such as economic inequality or risk factors like stress, diet or environmental hazards,” said Papanicolas, who directs the School of Public Health’s Center for Health System Sustainability. “If we want to improve health in the U.S., we need to better understand the underlying factors that contribute to these differences — particularly amongst similar socioeconomic groups — and why they translate to different health outcomes across nations.”
According to the study, individuals in the wealthiest quartile had a death rate that is 40% lower than for individuals in the poorest quartile. Individuals in Continental Europe died at rates approximately 40% lower than participants in the U.S. throughout the study period. Participants from Southern Europe had estimated death rates around 30% lower than U.S. participants over the study period, while participants from Eastern Europe have estimated death rates 13% to 20% lower.
“We found that where you stand in your country’s wealth distribution matters for your longevity, and where you stand in your country compared to where others stand in theirs matters, too” said study author Sara Machado, a research scientist at Brown’s Center for Health System Sustainability. “Fixing health outcomes is not just a challenge for the most vulnerable — even those in the top quartile of wealth are affected.”
The study, which analyzed data from the U.S. Health and Retirement Study and Europe’s Survey of Health, Ageing and Retirement, underscores how weaker social safety nets and structural disparities in the U.S. may contribute to poorer survival rates across all wealth groups. These shortcomings disproportionately affect the poorest residents but ultimately leave even the wealthiest Americans more vulnerable than their European counterparts, the researchers argued.
The study noted how systemic cultural and behavioral factors, such as diet, smoking and social mobility, may also play a role. For example, smoking rates and living in rural areas — both linked to poorer health — were more common in the U.S.
The researchers also highlighted a “survivor effect” in the U.S., where poorer individuals with worse health outcomes were more likely to die earlier, leaving behind a population that is healthier and wealthier as age groups progress. This creates the illusion that wealth inequality decreases over time, when in reality it’s partly due to the early deaths of the poorest Americans.
“Our previous work has shown that while wealth inequality narrows after 65 across the U.S. and Europe, in the U.S. it narrows because the poorest Americans die sooner and in greater proportion,” Papanicolas said.
The researchers said the findings provide a sobering view of U.S. health outcomes and a call to action for policymakers to address a growing wealth-mortality gap with policies that have a broader focus than the health system’s shortcomings.
“If you look at other countries, there are better outcomes, and that means we can learn from them and improve,” Machado said. “It’s not necessarily about spending more — it’s about addressing the factors we’re overlooking, which could deliver far greater benefits than we realize.”
