A new study from the Brown School of Public Health found that Americans are more likely to die earlier than Europeans, even at the highest levels of wealth.
The study, published in the New England Journal of Medicine, followed around 74,000 adults aged 50 to 85 across the US and Europe from 2010 to 2022. Researchers grouped participants by wealth quartiles, then compared their survival rates.
In every wealth bracket, Americans had worse survival rates than their European counterparts. In fact, wealthy Americans had survival rates comparable to the poorest Europeans in countries like France and Germany.
“We thought the wealthiest in the US would at least match the wealthiest in Europe,” said Sara Machado, the first author on the study and a research scientist at the SPH’s Center for Health System Sustainability, or CHeSS. “But they didn’t.”
Instead of income, the study focused on wealth, which was defined by what people own, including savings and property. According to the researchers, wealth offers a fuller context when examining long-term access to resources, health stability and security.
The findings show how deeply inequality affects health in the US, said Irene Papanicolas, the study’s principal investigator and director of CHeSS. In countries with stronger social protections, like those in Europe, wealth is not as closely tied to life expectancy, she added.
“Your wealth matters for your health more in the US than in Europe,” Papanicolas added. “But it won’t buy you the same longevity.”
Machado noted that in some comparisons, survival patterns in the US more closely resemble those in Eastern Europe — where wealth inequality tends to be wider — compared to Western Europe.
“There’s a clear step ladder in the US,” she said. “The poorer you are, the worse your health outcomes. That’s less true in most of Europe.”
Astrid Van Wilder, a postdoctoral research associate at the School of Public Health, who was not involved in the study praised its design. Van Wilder also researches healthcare differences across countries. She said the focus on wealth, not income, makes the findings especially important.
“Wealth gives people security,” Van Wilder wrote in an email to The Herald. “And that security has a lasting impact on health.”
Although the study didn’t look at causes directly, policies in Europe — such as social care programs and “stronger safety nets” — likely play a role in equalizing health outcomes across economic groups, she added.
The researchers said the study is not meant to offer immediate policy recommendations, but they hope it sparks conversation.
“I don’t think one study changes public health,” Machado said. “But I hope it adds to the debate.”
