Substantial loss of wealth during a 2-year period among older adults in the United States is associated with an increased risk for all-cause mortality, according to the results of a study published in JAMA.

There is considerable evidence for the contention that lower socioeconomic status increases the risk for poorer health outcomes. Negative wealth shocks, defined as a sudden loss of net worth of 75% or more during a 2-year period, or asset poverty, defined as 0 total net worth or negative net worth, usually increase stress and anxiety and diminish resources for health-related expenses and health-enhancing goods.

Lindsay R. Pool, PhD, from the Department of Preventive Medicine at the Northwestern University Feinberg School of Medicine in Chicago, Illinois, and colleagues drew on data from the Health and Retirement Study, a national prospective cohort study of 8714 US adults between the ages of 51 and 61 years at study entry. These adults were first assessed for negative wealth shock in 1994 and then biennially through 2014. Mortality data came from the National Death Index and postmortem interviews with family members. Women constituted 53% of the study population.

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Over the course of the study, 2430 experienced a negative wealth shock, 749 had asset poverty at baseline, and 5535 had positive wealth without shock. The investigators found that compared with continuously positive wealth, negative wealth shock was associated with a hazard ratio of 1.50 for mortality, a risk that is only slightly less than that associated with asset poverty (hazard ratio, 1.67). This increased risk for mortality did not differ according to initial level of wealth; thus, a dramatic loss of assets appeared to confer risk even among those who were left with relatively adequate assets.

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The authors noted there were a number of limitations to the study, including the failure to capture the effects of lesser asset losses (>25% or >50%) or losses occurring during a longer period (>2 years). The lower limit age cutoff of 51 years may miss the effects of asset losses earlier in life and could potentially have biased the conclusions toward the null. There also is the possibility of residual confounding despite efforts to adjust for conditions such as divorce, unemployment, and ill health that may precipitate wealth shocks.

The authors called for further research to determine possible mechanisms for the increased risk for death associated with sudden loss of wealth.


Pool LR, Burgard SA, Needham BL, Elliott MR, Langa KM, Mendes de Leon CF. Association of a negative wealth shock with all-cause mortality in middle-aged and older adults in the United States. JAMA. 2018;319(13):1341-1350.