‘The plot twist’: A study of 73,000 adults found America’s richest still die sooner than most Europeans
A Brown University study published last year in the New England Journal of Medicine found that Americans die sooner than Europeans at every level of wealth, and that the richest Americans fare no better than the poorest people in much of Western Europe.
Key points
- it narrows because the poorest Americans die sooner and in greater proportion,” explains Papanicolas, a professor of health services, policy, and practice who directs Brown’s Center for Health System Sustainability.
- spent an estimated $14,775 per person on health care in 2024, nearly $7,000 more than the average comparable wealthy country, according to the Peterson-KFF Health System Tracker.
- Survival among America’s richest quartile was statistically equivalent to that of the poorest quartile in countries like France, Germany, and the Netherlands.
“The plot twist is that even the wealthiest quartile of Americans does not have better outcomes than most of northern and Western Europeans,” says Sara Machado, a research scientist at Brown’s Center for Health System Sustainability.
Additional details
- “We found that where you stand in your country’s wealth distribution matters for your longevity, and where you stand in your country compared to where others stand in theirs matters, too,” Machado says.
- Across the board, people in continental Europe died at rates about 40% lower than Americans over the study period, according to Brown.
- About 26.7 million Americans went uninsured for all of 2025, Census data shows, and about 2.6 million fewer Americans had ACA marketplace plans in early 2026 than in early 2025.
- “Fixing health outcomes is not just a challenge for the most vulnerable – even those in the top quartile of wealth are affected,” says Machado.
- Europe is also home to two of the so-called blue zones, Sardinia in Italy and Ikaria in Greece, where longevity is credited to activity, diet, rest, and strong social ties, though some researchers dispute the claims.
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