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Original Investigation
April 3, 2018

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

Author Affiliations
  • 1Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Sociology, University of Michigan, Ann Arbor
  • 3Department of Epidemiology, University of Michigan, Ann Arbor
  • 4Institute for Social Research, University of Michigan, Ann Arbor
  • 5Department of Biostatistics, University of Michigan, Ann Arbor
  • 6Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 7Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
  • 8Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
JAMA. 2018;319(13):1341-1350. doi:10.1001/jama.2018.2055
Key Points

Question  Is a large, sudden loss of wealth in middle or older age associated with higher risk of all-cause mortality?

Findings  In this prospective cohort study that included 8714 adults aged 51 to 61 years at study entry, participants who experienced a negative wealth shock during the 20-year follow-up compared with those with continuous positive wealth had a significantly increased risk of mortality (hazard ratio, 1.50).

Meaning  Sudden loss of wealth in middle or older age may be a risk factor for all-cause mortality.


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.