April 20, 2018

After a big financial loss, your risk of death rises 50%, study finds

Daily Briefing

    A new study suggests Americans who experienced a sudden and substantial loss of wealth in midlife may be 50% more likely to die over a 20-year time period than peers who did not experience such financial losses—an increase in mortality risk that an accompanying editorial says is comparable to a new diagnosis of coronary heart disease.

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    Study details

    For the study published last week in JAMA, researchers monitored 8,714 individuals born between 1931 and 1941 who are participating in the ongoing Health and Retirement Study over a 20-year time period. Over the course of the study's 20-year time period—1994 to 2014—the researchers found 2,823 participants died.

    The researchers tallied up the net worth of each participant—including the value of the participant's bank account, home, vehicles, business, retirement account, stock market investments, and any "other substantial assets"—at the start of the study and again every other year over the course of the 20-year time period. The researchers then assessed the participants' health, adjusting for age, body mass index, education, race and ethnicity, and smoking status.

    Key findings

    Overall, the researchers found that 28% of study participants—or 2,430—experienced what the researchers termed a "negative wealth shock," the loss of at least 75% of their net worth over a two-year time period. The researchers found women, minorities, those with health conditions, and those with low-incomes were more likely to report such loses. The median amount of loss was about 92% of their net worth.

    According to the researchers, individuals who experienced a negative wealth shock had a mortality rate of 64.9 deaths per 1,000 person-years. In comparison, the mortality rate among financially stable study participants was 30.6 deaths per 1,000 person-years.

    The researchers also assessed the mortality rate of study participants who at the start of the study had no net assets or had negative net worth. According to the researchers, those individuals had a mortality rate of 73.4 deaths per 1,000 person-years—meaning they had a 67% higher chance of premature death than those in the financially stable group. 

    Limitations

    The researchers cautioned that while they tried to account for participants' health, they could not rule out the possibility that health issues may have trigged negative wealth shock, rather than vice versa—and that those health issues independently increased participants' mortality risk.

    However, while they did not claim causation between negative wealth shock and mortality, the researchers hypothesized that negative wealth shock may adversely affect people's mortality rate by increasing the risk of depression or spurring additional stress, high blood pressure, and/or inflammation among affected individuals—all of which could increase the risk of serious heart issues. In addition, such a substantial loss of wealth may have caused people to skip necessary—but potentially costly—medical appointments or prescriptions, the researchers wrote.

    Discussion

    According to Lindsay Pool, lead author on the study and assistant professor of preventive medicine at Northwestern University, the study is the first to examine the long-term relationship between mortality risk and a sudden and significant loss of wealth—previous research has focused solely on short-term health effects. 

    Pool also pointed out that one interesting facet of the findings was that "someone's starting point—whether your net worth is $50,000 or $500,000 or $5 million—… doesn't seem to matter in terms of health risk. Losing 75% or more of that creates that increased risk of mortality." As a result, the researchers noted that "wealth shock may represent a potential risk factor for mortality across the socioeconomic spectrum."

    In addition, Pool expressed surprise at the comparable mortality rates between those suffering a negative wealth shock and those who never had much money, stating, "You would hope that having had some money at some point would provide some protective effect," but the findings demonstrate that "having wealth and losing it suddenly carries almost the same level of risk for premature mortality as never having wealth."

    Pool added, "Unfortunately, there is not a simple take-home message for patients, like 'stop smoking' or 'eat more fruits and vegetables' … And even things that we think might help, like 'keep going to the doctor' or 'find ways to manage stress' are easier said than done when your financial situation has just radically changed."

    Comments

    In an editorial accompanying the study, Alan Garber, provost at Harvard University, wrote, "The approximately 50% relative increase in all-cause mortality that follows a financial loss of this magnitude is similar to the increase associated with a new diagnosis of coronary heart disease,"

    However, Garber also echoed the researchers' warning on association versus causation, stating that while the study shows loss of wealth and mortality risk "go hand-in-hand," it "does not prove that loss of wealth directly causes illness and death."

    He pointed out that study participants who suffered negative wealth shock at the start of the study had lower income and less wealth, were more likely to smoke and report poor health, suffer from a mental health condition, and report at least one limitation that affected their daily living activity. "Their characteristics resembled those of the 'asset poverty at baseline' respondents, who had negative net worth at study entry," Garber wrote. "These characteristics are associated with increased mortality, raising the possibility that differences in characteristics that the study did not assess, including health behaviors and refined measures of health status at baseline, might contribute to the excess mortality attributed to the wealth shocks."

    That said, Garber called on providers to take note of patients' financial resources. "A wealth shock is a severe disruption in the life of any patient that has implications for health behaviors and well-being," Garber wrote. "An opportunity to build empathy and offer support will elude clinicians who fail to recognize such a profound event and its meaning for their patient’s future" (Lou, MedPage Today, 4/3; Johnson, "WonkBlog, Washington Post, 4/3; Rapaport, Reuters, 4/3; Stein, "Shots," NPR, 4/3; Kaplan, "Science Now," Los Angeles Times, 4/3).

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