Wealth-related inequalities in self-reported health status in the United States and 14 high-income countries

Objective

To examine wealth-related inequalities in self-reported health status among older population in the United States and 14 European countries.

Data Sources and Study Setting

We used secondary individual-level data from Health and Retirement Survey (HRS) and the Survey of Health, Ageing, and Retirement in Europe (SHARE) in 2011 and 2019.

Study Design

In this cross-sectional study, we used two waves from HRS (wave 10 and 14) and SHARE (wave 4 and 8) to compare wealth-related health inequality across countries, age groups, and birth cohorts. We estimated Wagstaff concentration indices to measure these inequalities across three age groups (50–59, 60–69, 70–79) and two birth cohorts (1942–1947, 1948–1953) in the US and 14 European countries.

Data Collection/Extraction Methods

We performed secondary analysis of survey data.

Principal Findings

Focusing on older population, we found evidence of wealth-related inequalities in self-reported health status across several high-income countries, with the US demonstrating higher levels of inequality than its European counterparts. The magnitude of these inequalities with respect to wealth remained unchanged over the study period across all countries. Our findings also suggest that wealth-related health inequalities differ at different stages of workforce engagement, especially in the United States. This could be explained either by potential redistributive effects of retirement or by uneven survivor effect, as less wealthy may drop out of the observations at a greater rate partly due to their poorer health.

Conclusions

Wealth-related inequalities in self-reported health status are strong and persistent across countries. Our results suggest that there is meaningful variation across high-income countries in health-wealth dynamics that merits further investigation to better understand whether certain health or welfare systems are more equitable. They also highlight the need to consider social policy and wealth redistribution mechanisms as strategies for improving population health among the less wealthy, in the United States and elsewhere.