Even the richest Americans die younger than their European counterparts

When it comes to health and longevity, wealth is often considered to provide a major safety net. But a new study suggests that in the United States, even the richest citizens aren’t living as long as their peers in Europe.

In fact, Americans of all wealth levels are more likely to die sooner than Europeans in the same financial brackets.

A research team from Brown University’s School of Public Health compared data from over 73,000 adults between the ages of 50 and 85 in the U.S. and Europe.

The study looked at mortality rates between 2010 and 2020, focusing on how wealth impacts survival across different regions.

Gaps in life expectancy

One of the clearest findings from the research is that while wealthier individuals tend to live longer than those with less money. This pattern is more extreme in the U.S. than in Europe.

In the United States, the gap between rich and poor is wide – and so is the gap in life expectancy. However, the differences don’t stop there.

At every level of wealth, Americans had higher death rates than their European counterparts. Rich Americans had similar survival rates to some of the poorest people in countries like France, Germany, and the Netherlands.

“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,” said Irene Papanicolas, one of the study’s authors.

Health issues in the United States

Life expectancy in the U.S. has been decreasing in recent years. This study adds depth to that picture, showing that the issue cuts across income levels. It’s not just the most vulnerable who are at risk.

“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.

“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.”

Europeans have a lower death rate

The researchers found that the top wealth quartile had a 40% lower death rate than those in the bottom quartile. However, across the board, Europeans fared better.

People in Continental Europe died at rates about 40% lower than Americans during the study. Southern Europeans had a 30% lower death rate. Those in Eastern Europe, however, showed a 13% to 20% advantage over U.S. residents.

According to the researchers, Europe’s stronger social safety nets and public health systems likely play a role.

In contrast, the U.S. faces structural gaps that weaken health outcomes for everyone, not just those who struggle with poverty.

“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 Sara Machado, a co-author of the study.

“Fixing health outcomes is not just a challenge for the most vulnerable – even those in the top quartile of wealth are affected.”

Cultural and regional factors matter

Beyond money and healthcare systems, the study also considered lifestyle and cultural differences.

Smoking, poor diet, and living in rural areas – factors that can lead to worse health – are more common in the U.S. These behavioral patterns could explain part of the mortality gap.

The researchers pointed out what they call a “survivor effect.” In the U.S., poorer individuals often die earlier.

This results in older age groups skewed toward wealthier and healthier individuals, giving a false impression that wealth disparities fade with age.

Better health outcomes are possible

The findings offer a difficult but important message. Better health outcomes are possible – but they require more than just medical solutions.

Policymakers will need to look at the bigger picture, including income inequality, access to preventative care, and environmental factors.

“If you look at other countries, there are better outcomes, and that means we can learn from them and improve,” said Machado.

“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.”

The full study was published in the journal New England Journal of Medicine.

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