Rising wealth has not closed the life-expectancy gap between the United States and Europe. A Brown University study tracking more than 73,000 adults found that mortality rates were higher in the U.S. across every wealth group. The survival outcomes of America’s wealthiest quarter were roughly comparable to those of the poorest quarter in France, Germany and the Netherlands, suggesting the health gap extends beyond low-income households and reflects broader differences in health systems and social conditions.
Study followed adults in the U.S. and 16 European countries
Published in The New England Journal of Medicine, the study included more than 73,000 adults aged 50 to 85 in the United States and 16 European countries. Researchers began tracking participants in 2010 for about a decade, drawing on the U.S. Health and Retirement Study (HRS) and Europe’s SHARE survey.
Mortality among the wealthiest people in Northern and Western Europe was about 35% lower than among the wealthiest Americans. Across the study period, mortality was about 40% lower in continental European countries and about 30% lower in Southern European countries than in the U.S. The researchers said both a person’s position in their country’s wealth distribution and differences in wealth and health between countries were linked to longevity.
Sarah Machado, a research scientist at Brown University’s Center for Health System Sustainability, said one striking finding was that even Americans in the top wealth quartile had worse health outcomes than people in most Northern and Western European countries. That runs counter to the common view that wealth in the U.S. is enough to secure better health.
U.S. health spending is high, but coverage gaps persist
Per-capita health spending in the U.S. was estimated at $14,775 in 2024, nearly $7,000 more than the average for comparable high-income countries. Those countries had average life expectancy of 82.7 years, 3.7 years above the U.S. figure. Higher spending has not ensured broad insurance coverage: Census Bureau estimates put the number of Americans without health insurance at about 26.7 million for all of 2025. Enrollment in Affordable Care Act (ACA) marketplace plans in early 2026 was also about 2.6 million lower than in early 2025.
Machado said improving health outcomes is not only a matter of supporting the most vulnerable; people near the top of the wealth distribution are affected as well. The study pointed to possible contributors including higher U.S. rates of preventable deaths related to firearms, alcohol and suicide, as well as higher cardiovascular mortality.
Senior author Erin Papanicolas, a professor of health services, policy and practice at Brown and director of the Center for Health System Sustainability, also cited the relatively weaker U.S. social safety net and the closer link between health insurance and employment.
Lifestyle and inequality may widen the gap
Researchers also noted the higher share of Americans who smoke or live in rural areas, both of which are associated with poorer health. Diet and sedentary lifestyles may also play a role. Heart disease and cancer remain the country’s two leading causes of death.
By contrast, Italy’s Sardinia and Greece’s Ikaria are often cited as longevity hotspots, with explanations including more physical activity, diet, rest and social connection. Some claims about these so-called Blue Zones have, however, been questioned by researchers.
The wealth gap is wider in the U.S. than in Europe and may compound health disparities. Papanicolas said earlier research by the Brown team found that wealth gaps between the U.S. and Europe narrow after age 65, but that some of the narrowing in the U.S. reflects poorer people dying earlier and in greater numbers. A smaller gap in the statistics, in other words, does not necessarily mean conditions have improved for lower-income groups.
U.S. life expectancy rebounds, but remains below Europe’s
U.S. life expectancy reached 79 years in 2024, the highest level on record. The recent increase was driven mainly by the fading effects of the COVID-19 pandemic. Centers for Disease Control and Prevention data also showed declines in drug-overdose deaths and suicides in 2024. Those improvements have not erased the life-expectancy gap with Europe.
Papanicolas said improving U.S. health outcomes will require a better understanding of why countries differ, particularly why people with similar socioeconomic circumstances can have different health outcomes. Machado said much of the challenge is collective, while individuals also need to consider when to retire, how to plan for retirement and what life after retirement will look like. Outcomes in other countries suggest that better health does not necessarily require higher spending; identifying overlooked factors may also matter.