A startling new study has revealed that Americans at every wealth level—including the richest quartile—face significantly higher mortality rates than their European peers, challenging long-held assumptions about wealth and longevity in the United States.
The research, published in the New England Journal of Medicine by a team from Brown University School of Public Health, found that the wealthiest Americans have survival rates comparable to the poorest residents in western European countries like Germany, France, and the Netherlands.
“The findings are a stark reminder that even the wealthiest Americans are not shielded from the systemic issues in the U.S. contributing to lower life expectancy, such as economic inequality or risk factors like stress, diet or environmental hazards,” said Irene Papanicolas, a professor of health services, policy and practice at Brown who directed the study.
The comprehensive analysis tracked more than 73,000 adults aged 50 to 85 across the United States and 16 European countries over a decade. During the median 10-year follow-up period, nearly 19% of participants died, with clear patterns emerging along both wealth and geographic lines.
While the researchers confirmed that individuals with greater wealth tend to live longer in all countries studied, the survival advantage of wealth was most pronounced in the United States. Americans in the top wealth quartile had a 40% lower death rate than those in the poorest quartile—yet even these wealthy Americans died at rates higher than comparably wealthy Europeans.
The mortality gap between Americans and Europeans was substantial across all regions. Americans died at rates approximately 40% higher than residents of Continental Europe, 30% higher than those in Southern Europe, and 13-20% higher than Eastern Europeans during the study period.
“We found that where you stand in your country’s wealth distribution matters for your longevity, and where you stand in your country compared to where others stand in theirs matters, too,” explained study author Sara Machado, a research scientist at Brown’s Center for Health System Sustainability. “Fixing health outcomes is not just a challenge for the most vulnerable—even those in the top quartile of wealth are affected.”
The research offers several potential explanations for America’s mortality disadvantage. The United States has a significantly weaker social safety net than most European countries, which may leave even wealthy Americans more vulnerable to health shocks. Lifestyle factors like diet, smoking, and rural living—all linked to poorer health outcomes—were also more prevalent in the American population.
Perhaps most concerning, the researchers identified a troubling “survivor effect” in the United States, where poorer individuals with worse health outcomes were more likely to die earlier. This creates the misleading impression that wealth inequality narrows with age, when in reality it reflects the early deaths of the poorest Americans.
“Our previous work has shown that while wealth inequality narrows after 65 across the U.S. and Europe, in the U.S. it narrows because the poorest Americans die sooner and in greater proportion,” Papanicolas noted.
The findings come as U.S. life expectancy has been declining in recent years, a trend that predates the COVID-19 pandemic. This study provides a more granular view of how this decline affects Americans across different wealth levels and suggests that the factors driving America’s health disadvantage cut across socioeconomic lines.
Health policy experts have long debated whether America’s healthcare spending—the highest per capita in the world—delivers appropriate value. This research suggests that spending alone may not address the fundamental factors driving health disparities.
“It’s not necessarily about spending more—it’s about addressing the factors we’re overlooking, which could deliver far greater benefits than we realize,” Machado said. “If you look at other countries, there are better outcomes, and that means we can learn from them and improve.”
The researchers hope these findings will prompt policymakers to look beyond simply reforming healthcare delivery and consider broader social and environmental factors that influence health outcomes for all Americans, regardless of their wealth.
As the study makes clear, even having significant financial resources cannot fully insulate Americans from the systemic issues that contribute to the nation’s growing mortality gap with peer countries. For a nation that prides itself on opportunity and achievement, this research presents both a challenge and a path forward toward healthier, longer lives for all.
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