We have known for a long time that having a low income and a poor education are associated with increased mortality.
But what happens to people who appear to be living the American Dream, and then hit a roadblock? Who suffer sudden financial ruin, and can't bounce back?
A 20-year period that included the Great Recession of 2007-2009 provided health researchers with a natural experiment to help answer that question in a recent article in the Journal of the American Medical Association.
Stockbrokers jumped from skyscrapers to their deaths when the stock market crashed in 1929, signaling the start of the Great Depression. But that was a long time ago, and fortunately we didn't see that kind of reaction in the recent recession.
Still, this study notes, for many the devastation of lost prosperity was no less profound in the more recent crisis.
Researchers looked at 8,741 American adults, ages 51 to 61, most of whom were doing pretty well financially at some point in their careers. They were part of the Health and Retirement Study, a nationally representative trial that tracks health and economic characteristics of middle-aged and older folks living in the United States. They were followed for 20 years, from 1994 until 2014. The point was to see whether a negative "wealth shock" — losing more than 75 percent of one's self-reported assets over a two-year period — was associated with poor health outcomes.
Here is what the study found:
- More than one-fourth of people in the study experienced a major decline in their wealth, and 7 percent ended up in long-term poverty.
- A large decline in wealth was more likely in women, Hispanics, and African Americans — all of whom were more likely to have started the study with a lower net worth than white men.
- The most important medical finding was that this steep decline in wealth was associated with major health problems, and a much higher risk of dying younger.
- Even those who remained fairly well off after a wealth shock took a health hit, perhaps because the experience of losing so much was so traumatic.
- Losing one's home was associated with an even higher chance of dying.
- Nearly 1,000 participants in the study (more than 10 percent) experienced more than one "wealth shock" during the 20 years of the study. Fewer than 10 percent (749) were below the poverty level when the study began.
- Of those who experienced a wealth shock, the average loss of net worth was 92.4 percent, or just over $100,000.
- Just 7.5 percent of participants saw their net worth increase during the study period — but this was not connected with an improvement in health.
- Reasons for premature death may have included loss of health-care coverage, the emotional stress of economic loss, elevated blood pressure due to stress, increased depression, and losing interest in maintaining healthy habits, researchers speculated.
- Reasons why wealth declined were not well outlined, but most likely included homes losing value during the financial crisis, the stock market decline, and lack of health insurance leading to personal bankruptcy. Of note, the study period was mostly before introduction of the Affordable Care Act, which could help prevent medical financial ruin in the future.
I have been a practicing cardiologist throughout the course of this study and have seen many of my patients face serious medical consequences after a financial catastrophe. One especially haunts me.
After a heart attack, this patient took action to protect his health right away. He started exercising, lost a significant amount of weight, and seemed committed to his new lifestyle.
Then, a few years after the recession started, he lost his job. I didn't know this, because he stopped coming to my office. I tried to contact him, but he didn't return my phone calls.
Then, after a few years had passed, he came back to my office. He was heavier than he was when he had his heart attack, his personal life was a shambles, and he was having some chest discomfort. He hadn't taken his medications for years because he couldn't afford them.
We helped him find affordable insurance, and he is back on medication. But he no longer seems to care about getting his health back. I don't know that he will ever fully recover from his "wealth shock."
I have long suspected that stories like this were not uncommon. But still, this new study's conclusions come as a chilling reminder that no amount of modern medicine may be able to help when a person suffers a devastating economic injury.