A new international study reveals that wealth is strongly linked to longer life expectancy—and the divide is notably wider in the United States than in Europe. The findings, published in the April 3 issue of the New England Journal of Medicine, raise concerns about the impact of income inequality on public health outcomes.

Led by Dr. Sara Machado from the Brown University School of Public Health, the research analyzed data from more than 73,000 adults aged 50 to 85 across the United States and 20 European countries. Participants were drawn from two major databases: the Health and Retirement Study in the U.S. and the Survey of Health, Ageing, and Retirement in Europe, covering the years 2010 to 2022.

The study found that over a median follow-up of 10 years, 18.7 percent of participants had died. However, individuals in higher wealth brackets consistently had lower mortality rates. After adjusting for age and other factors, the risk of death decreased steadily across wealth quartiles: those in the second, third, and top quartiles had a 20%, 32%, and 40% lower risk of dying, respectively, compared to the poorest group.

Perhaps the most striking revelation was the disparity between countries. Wealth-based survival gaps were significantly wider in the United States than in Europe. Moreover, wealthier Europeans—particularly those in Northern and Western Europe—often had higher survival rates than even the wealthiest Americans. In fact, the life expectancy of the wealthiest U.S. citizens was nearly the same as that of the poorest in Northern and Western Europe.

“We found that wealth was associated with mortality across the United States and Europe,” the authors wrote. “But the difference in mortality between the top and bottom quartiles of wealth appeared to be larger in the United States than in Europe.”

The findings underscore the role that social safety nets, healthcare access, and economic policies may play in shaping health outcomes—suggesting that wealth inequalities translate more acutely into survival gaps in countries like the U.S., where access to healthcare and social services may be more dependent on financial means.

Public health experts say the study adds to growing evidence that socioeconomic factors can be as important as medical ones in determining how long people live.