Makaroun LK, et al. - The relationship of wealth with mortality and disability among older adults in the United States and England was ascertained in this study. It was concluded that the low wealth was related to death and disability in both the United States and England. They also noticed that 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.

Methods

• The US Health and Retirement Study (HRS) and English Longitudinal Study of Aging (ELSA) are nationally representative cohorts of community-dwelling older adults.
• In 2002, they scrutinized 12173 participants enrolled in HRS and 7599 enrolled in ELSA.
• Examinations 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.

Results

• For the mortality outcome, 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 investigated.
• Slightly more than 50% 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.
• They found increased risk of death and disability as wealth reduced.
• In the United States, participants aged 54 to 64 years in the lowest wealth quintile (Q1) (≤$39000) had a 17% mortality risk and 48% disability risk over 10 years, whereas in the highest wealth quintile (Q5) (>$560000) 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.