December 11, 2017

The poor get sick sooner and die younger in both the USA and the UK

In the later age cohorts, poor people are 3 to 4 times likelier to get ill and die than are wealthy people.  And, sadly for the authors below, the wonderful universal health care in the UK made no difference.

Their findings are in fact what always emerges when social class variables -- in this case wealth -- are studied.  Poverty is a major influence on death and all sorts of disease.  But medical researchers fear political incorrectness if they mention social class as an influence on their findings so ignore it for around 98% of the time in their research reports.  So it is worthwhile noting here one of the occasions when they have bitten the bullet.

They have several possible explanations for their findings and all their suggestions probably have some merit.  But they overlook the elephant in the room: genetic differences.  If genetics is not an influence on your lifespan, what would be?

So what genetic influence could explain the findings?  What widely-influential genetically determined human characteristic do we know of?  At the risk of sounding like a cracked-record, let me mention our old friend IQ again. I am repetitious about IQ because nature is. No matter what you study, IQ very frequently seems to pop up as an influence.  And I just report the truth, the whole truth and nothing but the truth -- vastly incorrect  though that sadly is these days.

Some people are born more functional in general. All their bits work well, including their brain. So they have high IQs. And it is very well established that high IQ people both live longer and are  more likely to get rich.  The old challenge: "If you are so smart, how come you aren't rich?" is well founded.  So the findings below can be explained as showing that long lifespans are largely inborn and that those so born are also likely to be rich because they will also have high IQs.  We already knew that from IQ research but it is nice to see the same effects emerging in medical research


Wealth-Associated Disparities in Death and Disability in the United States and England

Lena K. Makaroun et al.

Abstract

Importance:  Low income has been associated with poor health outcomes. Owing to retirement, wealth may be a better marker of financial resources among older adults.

Objective:  To determine the association of wealth with mortality and disability among older adults in the United States and England.

Design, Setting, and Participants:  The US Health and Retirement Study (HRS) and English Longitudinal Study of Aging (ELSA) are nationally representative cohorts of community-dwelling older adults. We examined 12 173 participants enrolled in HRS and 7599 enrolled in ELSA in 2002. Analyses were stratified by age (54-64 years vs 66-76 years) because many safety-net programs commence around age 65 years. Participants were followed until 2012 for mortality and disability.

Exposures:  Wealth quintile, based on total net worth in 2002.

Main Outcomes and Measures:  Mortality and disability, defined as difficulty performing an activity of daily living.

Results:  A total of 6233 US respondents and 4325 English respondents aged 54 to 64 years (younger cohort) and 5940 US respondents and 3274 English respondents aged 66 to 76 years (older cohort) were analyzed for the mortality outcome. Slightly over half of respondents were women (HRS: 6570, 54%; ELSA: 3974, 52%). A higher proportion of respondents from HRS were nonwhite compared with ELSA in both the younger (14% vs 3%) and the older (13% vs 3%) age cohorts. We found increased risk of death and disability as wealth decreased. In the United States, participants aged 54 to 64 years in the lowest wealth quintile (Q1) (≤$39 000) had a 17% mortality risk and 48% disability risk over 10 years, whereas in the highest wealth quintile (Q5) (>$560 000) participants had a 5% mortality risk and 15% disability risk (mortality hazard ratio [HR], 3.3; 95% CI, 2.0-5.6; P < .001; disability subhazard ratio [sHR], 4.0; 95% CI, 2.9-5.6; P < .001). In England, participants aged 54 to 64 years in Q1 (≤£34,000) had a 16% mortality risk and 42% disability risk over 10 years, whereas Q5 participants (>£310,550) had a 4% mortality risk and 17% disability risk (mortality HR, 4.4; 95% CI, 2.7-7.0; P < .001; disability sHR, 3.0; 95% CI, 2.1-4.2; P < .001). In 66- to 76-year-old participants, the absolute risks of mortality and disability were higher, but risk gradients across wealth quintiles were similar. When adjusted for sex, age, race, income, and education, HR for mortality and sHR for disability were attenuated but remained statistically significant.

Conclusions and Relevance:  Low wealth was associated with death and disability in both the United States and England. This relationship was apparent from age 54 years and continued into later life. Access to health care may not attenuate wealth-associated disparities in older adults.

SOURCE





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