Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States

Abstract

Importance: A sudden loss of wealth-a negative wealth shock-may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting.

Objective: To determine whether a negative wealth shock was associated with all-cause mortality during 20 years of follow-up.

Design, setting, and participants: The Health and Retirement Study, a nationally representative prospective cohort study of US adults aged 51 through 61 years at study entry. The study population included 8714 adults, first assessed for a negative wealth shock in 1994 and followed biennially through 2014 (the most recent year of available data).

Exposures: Experiencing a negative wealth shock, defined as a loss of 75% or more of total net worth over a 2-year period, or asset poverty, defined as 0 or negative total net worth at study entry.

Main outcomes and measures: Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.

Results: There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53% women), 2430 experienced a negative wealth shock during follow-up, 749 had asset poverty at baseline, and 5535 had continuously positive wealth without shock. A total of 2823 deaths occurred during 80 683 person-years of follow-up. There were 30.6 vs 64.9 deaths per 1000 person-years for those with continuously positive wealth vs negative wealth shock (adjusted hazard ratio [HR], 1.50; 95% CI, 1.36-1.67). There were 73.4 deaths per 1000 person-years for those with asset poverty at baseline (adjusted HR, 1.67; 95% CI, 1.44-1.94; compared with continuously positive wealth).

Conclusions and relevance: Among US adults aged 51 years and older, loss of wealth over 2 years was associated with an increased risk of all-cause mortality. Further research is needed to better understand the possible mechanisms for this association and determine whether there is potential value for targeted interventions.

Figure 1.. Adjusted Survival Curves for All-Cause Mortality by Asset Status, 1994-2014

Survival estimates are adjusted for covariates using weights estimated in the marginal structural models. Negative wealth shock was a time-varying exposure, and participants may contribute person-years at risk to both the positive wealth without shock and negative wealth shock groups across follow-up. Negative wealth shock vs positive wealth without shock (reference) had an adjusted hazard ratio of 1.50 (95% CI, 1.36-1.67); asset poverty at baseline vs positive wealth without shock, 1.67 (95% CI, 1.44-1.94). Median follow-up times were 20 years (interquartile range [IQR], 12-20 years) in the positive wealth without shock group, 12 years (IQR, 8-20 years) in the negative wealth shock group, and 16 years (IQR, 8-20 years) in the asset poverty at baseline group.

Figure 2.. Adjusted Hazard of Death by Post Hoc Subgroup Populations of Asset Status

Data markers indicate the marginal structural model–adjusted hazard ratios comparing the negative wealth shock group with the positive wealth without shock group; the error bars, corresponding 95% CIs. P values correspond with the statistical test for differences in the hazard ratios by the subgroup categories.