美国的财富再分配以延长寿命。

Wealth Redistribution to Extend Longevity in the US.

机构信息

Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston.

Harvard Medical School, Boston, Massachusetts.

出版信息

JAMA Intern Med. 2024 Mar 1;184(3):311-320. doi: 10.1001/jamainternmed.2023.7975.

DOI:10.1001/jamainternmed.2023.7975

PMID:38285594

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10825783/

Abstract

IMPORTANCE

The US is unique among wealthy countries in its degree of wealth inequality and its poor health outcomes. Wealth is known to be positively associated with longevity, but little is known about whether wealth redistribution might extend longevity.

OBJECTIVE

To examine the association between wealth and longevity and estimate the changes in longevity that could occur with simulated wealth distributions that were perfectly equal, similar to that observed in Japan (among the most equitable of Organisation for Economic Co-operation and Development [OECD] countries), generated by minimum inheritance proposals, and produced by baby bonds proposals.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study (1992-2018), a nationally representative panel study of middle-aged and older (≥50 years) community-dwelling, noninstitutionalized US adults. The data analysis was performed between November 15, 2022, and September 24, 2023.

EXPOSURE

Household wealth on study entry, calculated as the sum of all assets minus the value of debts and classified into deciles.

MAIN OUTCOMES AND MEASURES

Weibull survival models were used to estimate the association between per-person wealth decile and survival, adjusting for age, sex, marital status, household size, and race and ethnicity. Changes in longevity that might occur under alternative wealth distributions were then estimated.

RESULTS

The sample included 35 164 participants (mean [SE] age at study entry, 59.1 [0.1] years; 50.1% female and 49.9% male [weighted]). The hazard of death generally decreased with increasing wealth, wherein participants in the highest wealth decile had a hazard ratio of 0.59 for death (95% CI, 0.53-0.66) compared with those in the lowest decile, corresponding to a 13.5-year difference in survival. A simulated wealth distribution of perfect equality would increase populationwide median longevity by 2.2 years (95% CI, 2.2-2.3 years), fully closing the mortality gap between the US and the OECD average. A simulated minimum inheritance proposal would increase populationwide median longevity by 1.7 years; a simulated wealth distribution similar to Japan's would increase populationwide median longevity by 1.2 years; and a simulated baby bonds proposal would increase populationwide median longevity by 1.0 year.

CONCLUSIONS AND RELEVANCE

These findings suggest that wealth inequality in the US is associated with significant inequities in survival. Wealth redistribution policies may substantially reduce those inequities and increase population longevity.

摘要

重要性

美国在财富不平等程度及其健康结果方面是富裕国家中独一无二的。众所周知，财富与长寿呈正相关，但人们对财富再分配是否会延长寿命知之甚少。

目的

研究财富与长寿之间的关联，并估计通过完全平等的财富分配（类似于经合组织中最公平的国家之一日本的分配）、最低继承提议和婴儿债券提议产生的类似于日本的财富分配，可能会对寿命产生的变化。

设计、环境和参与者：这项纵向队列研究分析了健康与退休研究（1992-2018 年）参与者中财富与生存之间的关联，这是一项针对中年和老年（≥50 岁）社区居住、非机构化美国成年人的全国代表性小组研究。数据分析于 2023 年 9 月 24 日在 2022 年 11 月 15 日之间进行。

暴露

进入研究时的家庭财富，计算为所有资产减去债务的总和，并分为十分位数。

主要结果和措施

使用 Weibull 生存模型估计个人财富十分位数与生存之间的关联，同时调整年龄、性别、婚姻状况、家庭规模以及种族和民族。然后，估计在替代财富分配下可能发生的寿命变化。

结果

样本包括 35164 名参与者（研究开始时的平均[SE]年龄为 59.1[0.1]岁；50.1%为女性，49.9%为男性[加权]）。一般来说，死亡的风险随着财富的增加而降低，与最低十分位相比，最高十分位的参与者的死亡风险比为 0.59（95%CI，0.53-0.66），对应于生存的 13.5 年差异。完全平等的财富分配模拟将使人口寿命中位数增加 2.2 年（95%CI，2.2-2.3 年），从而完全缩小美国与经合组织平均水平之间的死亡率差距。模拟最低继承提议将使人口寿命中位数增加 1.7 年；模拟类似于日本的财富分配将使人口寿命中位数增加 1.2 年；模拟婴儿债券提议将使人口寿命中位数增加 1.0 年。