JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2017.3903 (2017)

Socioeconomic status has profound effects on people’s relative health prospects. Income is associated with disparities in mortality and disability risks across the life course. However, when studying older, retired groups, wealth — in the form of assets, investments and savings — may be a better metric of resource differences than income.

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A paper by Lena Makaroun, of the University of Washington, and colleagues used data from nationally representative, longitudinal surveys to examine the relationship between wealth and mortality and age-related disability risk among 54–76 year olds in the United States and England. The study found a strong association between low wealth and adverse health outcomes. Among 54–64 year olds in the United States, the mortality hazard ratio was 3.3 and the disability hazard ratio was 4.0 between the poorest and richest wealth quintiles. In England, the differences were 4.4. and 3.0, respectively. The risk ratios were similar in those aged 66–76 in both countries, despite the fact that citizens gain access to safety-net programmes typically at age 65 and hence one might expect an attenuation of the disparities in that age group. The biggest impact was seen among the poorest, with relatively modest differences in wealth having a relatively large impact on mortality and disability risk.

The study is further evidence for the strong link between socioeconomic status and health and suggests that targeting heath policy at those with the lowest wealth will have the greatest positive effect on population health outcomes.