Health  

Poorer people are more likely to become disabled or die early


Bing in relatively poor financial health when middle-aged or older appears to significantly increase the risk for developing a disability or dying early.

The observation stems from an analysis of data from the United States and England that drew links between wealth and health among almost 20,000 people aged 54 to 76.

For example, over a 10-year period, Americans aged 54 to 64 who were in the lowest wealth bracket (with financial holdings of $39,000 or less) faced a 48 percent risk for developing a disability and 17 percent risk for dying prematurely, the investigators found.

By comparison, their peers in the highest bracket (with holdings equaling $560,000 or more) had a 15 percent disability risk and 5 percent premature death risk.

The fact that people in England are guaranteed cradle-to-grave government-run health care coverage, while Americans are not, did not seem to have much effect.

The study was published online October 23 in JAMA Internal Medicine.”We saw similar relationships in both the United States and England, which are two countries with very different health and social safety-net systems,” explained Dr. Lena Makaroun, the study’s lead author.

“We also saw the same pattern for older adults, both above and below age 65,” she said.Makaroun noted that in the United States, Medicare becomes available at age 65, and both countries also start dispensing retirement benefits in the form of U.S. Social Security and the State Pension in England around that age.

“Seeing similar results in both countries, and in both age groups, suggests that [additional] health care or [additional] financial benefits later in life may not be enough” when it comes to trying to improve the health prospects of people who enter their later years in poor financial shape, said Makaroun. She is a research fellow with the VA Puget Sound Health Care System and the division of gerontology and geriatric medicine at the University of Washington in Seattle.

For the study, the researchers focused on two groups of study participants — those aged 54 to 64 (“middle aged”), and those aged 66 to 76.Each person’s wealth status was calculated based on their total assets — including real estate, vehicles, retirement savings and investment accounts — minus their total debts.

Disability status was assessed on the basis of whether participants could, on their own, get dressed, bathe, eat, get in and out of bed, and use the bathroom.

The researchers determined that, in both countries, the poorest people in their mid-50s or older faced a “high” absolute risk for becoming disabled or dying early. That absolute risk did rise among the older group, relative to the middle-aged group.

But in relative terms, the link between being in the poorest financial health and the poorest physical health, compared with the richest individuals, held steady across the 54-and-up age spectrum in both countries.

Still, the study team also observed that even those who were only slightly better off than the poorest participants saw their health prognosis markedly improve.

Makaroun stressed that the study could not prove that poverty actually causes early death or disability. But she suggested that main stressors associated with poverty — such as unstable housing, trauma and sleep problems — may take a toll.

“And from our study it does not seem that universal health care alone can eliminate the inequalities in health outcomes for low-wealth individuals that we see,” she said.

Co-author of an accompanying editorial, Dr. Martin McKee, a professor of European public health with the London School of Hygiene & Tropical Medicine, suggested that the connection between higher wealth and better health could have a lot to do with empowerment.

“Most poor people know what they should do to stay healthy,” he explained. “However, if they are struggling with trying to hold down several poorly paid jobs, lack of child care, and debt, it is unrealistic to expect them to travel further and pay higher prices for healthy foods, to go to the gym, and the like.”

Having resources also “seems to give people a more positive outlook on life, seeing the value of investing in their future through healthy activities,” McKee added. “Essentially, they see a point in investing for the long term, while those who see the future as just more pain, worry and misery don’t.”



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