Why Do Americans Die Younger Than Europeans?
A New England Journal of Medicine study found clear longevity differences between Americans and Europeans across wealth levels. The researchers also found that while the wealthiest Americans live longer than the poorest, the wealth-mortality gap in the U.S. is far more pronounced than in Europe
We are a team of health policy researchers who study health systems and how their performance compares across countries.
We analyzed survey data from 73,838 adults ages 50 to 85 across the U.S. and 16 European countries over a 12-year period and compared how long people across the wealth spectrum lived during the course of our study.
The 16 European countries are grouped into European regions: Northern and Western, Southern and Eastern Europe.
Our research revealed that people in the wealthiest 25 percent of the study population across the U.S. and Europe were 40 percent less likely to die during the study period than the poorest quarter of people.
The wealthiest 25 percent of people in Northern and Western Europe had mortality rates that were about 35 percent lower than participants in the wealthiest quartile in the U.S. For those from Southern Europe, during the study period, this value ranged from 24 to 33 percent.
For those from Eastern Europe, the value ranged from one to seven percent. The poorest individuals in the U.S. appear to have the worst survival, including when compared with the poorest quarter of people in each European region.
Why it matters
Wealth inequality has been rising for decades, but more so in the U.S. than in Europe due to a widening gap between the wealth of the richest and the poorest.
At the same time, despite spending significantly more on healthcare than other wealthy nations, overall, the U.S. consistently demonstrates worse health outcomes, such as higher infant mortality rates and avoidable mortality.
Our study also reveals a wider wealth-mortality gap in the U.S. when compared with Europe. In other words, personal wealth does buy more years of life in the U.S. than in Europe.
These findings suggest that personal wealth alone is not enough to compensate for other factors that tend to affect how long people live, such as health behaviors like smoking or heavy drinking, education or social support.
At its core, our research suggests that health outcomes are shaped by much more than just healthcare systems. It is likely that economic and social policies — from education and employment to housing and food security — play a crucial role in determining how long people live, including across the wealth distribution.
European countries have found ways to reduce health disparities without dramatically increasing health spending. By distributing health-promoting resources more equally across wealth groups, these nations may have created environments where longevity is less dependent on individual wealth.
What still isn’t known
While our study shows clear longevity differences between Americans and Europeans across wealth levels, more work still needs to be done to determine which specific aspects of European social systems — whether healthcare delivery, education access, retirement security or tax policies — most effectively protect health regardless of personal wealth.
Pinpointing exactly how these factors interact with wealth to influence health outcomes would allow researchers to identify which European policies could be most successfully adapted to improve longevity for all Americans.
What’s next
Looking ahead, we plan to identify which of those policy levers might be most effective in reducing mortality gaps.
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Header image: Legacy.com
About the authors: Sara Machado is a research scientist in Health Economics at Brown University. Irene Papanicolas is a professor of Health Services, Policy and Practice at Brown University.
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Are abortions included in death stats in America?
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