Do the wealthy have a health advantage? An investigation of wealth as a measure of socioeconomic status

Background. In the health literature, wealth is often overlooked as a measure of socioeconomic status.;Objectives. We explored the association between wealth and various health outcomes, namely: hypertension, obesity, smoking, self-reported general health status (GHS) and mortality.;Methods. We used data from the Panel Survey of Income Dynamics (PSID), a longitudinal study of a nationally representative US population. PSID data from 1984 to 2005 were used to evaluate the association between wealth and mortality and GHS and data from 1999 to 2005 to explore the relationship between wealth and hypertension, smoking and obesity. Inverse probability weights were employed to handle time-varying confounding and to estimate both relative and absolute measures of effect. Wealth was defined as inflation adjusted net worth and specified as a 6 category variable: a category for those with less than or equal to 0 wealth and 5 quintiles of positive wealth.;Results. In the fully adjusted model, the risk of becoming obese was inversely related to wealth; there was a 40% to 89% higher risk of becoming obese and 11 to 25 excess cases of obesity (per 1000 persons) among the less wealthy groups relative to the wealthiest quintile. Smoking initiation had a similar but more moderate effect, while hypertension incidence had a weak association with wealth, showing fewer excess cases (between 4 and 9) among the less wealthy groups. There was a 17% to 54% higher risk of falling into poor health and 6 to 22 excess cases of poor health (per 1000 persons) among the 4 less wealthy groups relative to the wealthiest quintile. The overall wealth-mortality association revealed between a 25% and 83% increased risk and between 2 and 5 excess cases of death (per 1000) among the less wealthy compared to the wealthiest.;Conclusion. There is a strong inverse association between wealth and incidence of obesity, poor health status and mortality, a moderate inverse association between wealth and smoking initiation and a weak inverse association between wealth and hypertension incidence. Wealth is a useful measure of SES and should be considered by future health researchers.