Financial hardship has been associated with risk factors for cardiovascular disease and all-cause mortality, but what about people who were once well-off only to lose their nest egg? Are they any better off than individuals who were never wealthy?
Barely, according to a new study in JAMA, which found that people who lost at least 75 percent of their net worth in a two-year period were at a 50 percent increased risk of dying over two decades compared to those who maintained positive wealth without a similar loss. Importantly, this ‘75 percent rule’ had a similar effect on mortality regardless of an individual’s baseline net worth.
“Wealth shock may represent a potential risk factor for mortality across the socioeconomic spectrum,” wrote the authors, including lead researcher Lindsay R. Pool, PhD, with the department of preventive medicine at Northwestern University Feinberg School of Medicine.
Pool et al. studied 8,714 Americans aged 51 to 61 when the study began in 1994. They were assessed every two years through 2014 for specific health variables and asked to report on their financial assets.
A total of 2,430 (27.9 percent) experienced negative wealth shock—the 75 percent loss in net worth—while 749 had either zero or negative net worth at baseline. The latter individuals were categorized in the “asset poverty” group and demonstrated a 67 percent increased risk of death when compared to individuals who had positive wealth without shock.
For the group that experienced significant financial loss, the authors hypothesized a combination of psychosocial stress and a reduction in healthcare spending contributed to the higher mortality risk. A recent study showed the Great Recession was linked to rises in blood pressure and glucose levels, two risk factors for cardiovascular disease and death. Stress may also increase the risks of depression and suicide.
In addition, cash-strapped individuals could decide to delay or avoid receiving medical care or stop taking medication out of fear they can’t afford them, Pool and colleagues noted.
However, they pointed out their findings may not apply to younger U.S. adults or to the current era of the Affordable Care Act (ACA), which has reduced the number of uninsured Americans and could protect against such drastic losses from out-of-pocket expenses.
“It is possible that increased insurance coverage through the ACA has reduced the prevalence of negative wealth shocks driven by medical issues, and there may also be a reduced prevalence of delaying needed medical care after experiencing wealth shock,” Pool and coauthors wrote.
In an accompanying editorial, Harvard University’s Alan M. Garber, MD, PhD, said the results of the study were striking.
“The approximately 50 percent relative increase in all-cause mortality that follows a financial loss of this magnitude is comparable with the increase associated with a new diagnosis of coronary heart disease,” he wrote. “At least as surprising is that the wealth shocks were so common, occurring in nearly a quarter of this middle-aged to elderly group over two decades. For retirees and anyone else for whom continued employment in a satisfying remunerative job is not an option, it cannot be easy to accommodate such a large financial loss.”
Graber pointed out the individuals who experienced wealth shocks had characteristics that more closely mirrored those of the “asset poverty” group such as greater likelihoods of smoking, having a psychiatric condition and participating in limited physical activity. These similarities raise the question of whether it is these characteristics, not the financial loss, that are causing the higher death rate.
Nevertheless, Garber said it is “entirely plausible that wealth shocks harm health.” But since causality and specific mechanisms haven’t been determined, it is difficult to pinpoint targeted interventions that may help these patients, he wrote.
In the meantime, Garber suggested clinicians treat financial misfortune as a risk factor for mortality and understand it may impact a patient’s health.
“The social history conventionally includes questions about current living circumstances and occupation and often much else,” he wrote. “These questions may strengthen the bond between patient and physician as they guide a search for specific health conditions and behaviors. The rationale for exploring financial loss is similar: a wealth shock is a severe disruption in the life of any patient that has implications for health behaviors and well-being.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.