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A famous saying goes: It is better to be rich and healthy than poor and sick. A side-saying broadens this simple fact by clarifying that you would better be rich if you are sick. There have been numerous studies on the association of socioeconomic status with health and disease, and there is no need to enlarge on that. However, a new study from the United States, where money really talks, has found alarming data that must be discussed by the citizens and their administration [1]. The study analyzed data on a cohort of 51–61-year-old people at baseline, who were followed long-term. The participants of the Health and Retirement Study gave detailed information on their wealth (housing, businesses, individual retirement accounts, cash and savings accounts, investment holdings, loans, debts, etc.), and accordingly were grouped into wealthy or poor. Furthermore, they were divided into subgroups that considered changes in wealth during the study period, i.e. those who maintained or increased their wealth, those who lost wealth, and those who experienced ‘wealth shock’, defined as loss of at least 75% of their wealth during a period of 2 years. All-cause mortality data were obtained as well, which allowed examination of associations between mortality risk and economic status. The sample size was 8714 participants with a mean follow-up of 17.7 years, totaling 80,683 person-years; 26.2% experienced a negative wealth shock and 6.9% had long-term asset poverty. A total of 2823 participants died during follow-up. In the positive-wealth-without-shock reference group, the crude mortality rate was 30.6 deaths per 1000 person-years. By contrast, the crude mortality rates were 64.9 per 1000 person-years for those who experienced a negative wealth shock and 73.4 per 1000 person-years for those who had asset poverty.


  • Amos Pines
    Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel


  1. Pool LR, Burgard SA, Needham BL, et al. Association of a negative wealth shock with all-cause mortality in middle-aged and older adults in the United States. JAMA 2018;319:1341-50
  2. Sorlie PD, Backlund E, Keller JB. US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study. Am J Public Health 1995;85:949-56
  3. Hajat A, Kaufman JS, Rose KM, Siddiqi A, Thomas JC. Long-term effects of wealth on mortality and self-rated health status. Am J Epidemiol 2011;173:192-200 LK, Brown RT, Diaz-Ramirez LG, et al. Wealth-ass
  4. Makaroun LK, Brown RT, Diaz-Ramirez LG, et al. Wealth-associated disparities in death and disability in the United States and England. JAMA Intern Med 2017;177:1745-53
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