Poverty Is the 4th Leading Cause of Death in the US, Research Shows | Hacker News Reader

Poverty Is the 4th Leading Cause of Death in the US, Research Shows

commondreams.org

96 pointsPaul-Craft77 comments

Are the first 3 causes dying, aging, and poor health? As soon as you start allowing abstract concepts that contribute to a person's death to count as the cause of a person's death, this stops being an especially meaningful statistic. I'd much rather see a calculation of how many years of life are lost, an actually meaningful metric.

> I'd much rather see a calculation of how many years of life are lost, an actually meaningful metric.

How do you calculate the number of years lost? Do you subtract their age from the national age expectancy or do you run a prediction model to extrapolate the age each individual would have lived to given what data is available for them?

Those are both better ideas than the cited study!

> I'd much rather see a calculation of how many years of life are lost, an actually meaningful metric.

It's only a google search away! Looks like the rich live about 10 years longer than the poor in the US. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/

> Looks like the rich live about 10 years longer than the poor

At the extremes. The “gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women.” More troubling, between 2001 and 2014 “life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but increased by only 0.32 years for men and 0.04 years for women in the bottom 5%.”

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/

Tying healthcare to employment will only make this worse.

Common dreams is known for click bait stuff like this.

I’m not knowledgeable enough about this to have an opinion. But isn’t it valid to say that someone died from AIDS even if actual cause of death is pneumonia? If the underlying factor is very strong can’t that be seen as the cause of death?

> Poverty, which the study defines as less than half the median U.S. income

Is this the same definition of poverty used by the federal government for all other poverty-related statistics? If not, it sure is interesting that the study would come up with it's own definition. Unfortunately the links study appears to be behind a Jama pay wall, I'd love to see how they came up with that and whether it was defined before the study was conducted.

> The onset of the coronavirus pandemic in 2020 brought about a sharp increase in U.S. poverty as millions of people got sick, were thrown out of work, and lost health insurance.

Also interesting that the issues here would still be categorized as caused by poverty rather than the pandemic and our pandemic response. Poverty contributes plenty of issues that can lead to an early death, but if the study is attempting to roll those up and label the proximla cause of death as poverty how is the increase in poverty and related deaths not rolled up as an effect of the pandemic itself?

I can't read the firey letters, but it seems it's somewhere in here: https://www.federalregister.gov/documents/2023/01/19/2023-00...

The "federal poverty guidelines" are kind of useless on their own - you need the percentage adjustments that various states apply to handle the incredible cost of living differences that exist.

I can't say if it's in the paywalled study or just the article, but multiple stats and links used point back to government poverty data which would be using a different definition than the study.

At a minimum that would be sloppy journalism, but in my opinion any researcher should see that coming and use the standard definition that the study is clearly attempting to compare against. It really doesn't seem to make sense to redefine such a loaded term even if the federal definition is tedious to work with.

Agreed, the "poverty line" is such a well-defined term of art that you shouldn't even consider using the word unless you're referencing it (which can be fine to do the "200% of" math because that's often still quite low).

In this case it sounds like they'd be better off defining something else because "the half of the people below the median" has some obviously glaring issues right off the bat.

While I mostly agree, note that the definition in the study is not "the half of people below the median", it's "all the people earning less than half of the median income".

It is the national median though, which completely loses the fine-grained detail built into the national poverty statistics that adjust for cost of living at the state level.

I don't think I would actually say the federal metric itself is particularly useful, but so much existing data depends on it that it seems crazy to reinvent the meaning of what the poverty line is for one specific study.

> Poverty, which the study defines as less than half the median U.S. income

This seems odd as poverty is a function of households, not individual income. Half the median for a single person is very different from half the media. For a single person with 9 kids. Or two people living together.

And why half the median? Why not first quartile or quintile?

This is pretty complicated to measure, so it seems unusual to not use Census’ Official Poverty Measure [0] that has many factors and is based on family size.

I would expect discussion around why they created their own measure and didn’t use Census.

[0] https://www.census.gov/topics/income-poverty/poverty/guidanc...

That's more precise but also requires much more information. Recently I ran through that with a few different scenarios and most of them did come out really close to half of median. I can see why they would go with that number for simplicity and to reduce dependence on specific data and avoid accounting for reporting error in the data.

Definitely, it’s harder to use. But I’d rather not do analysis than do wrong analysis.

If I can’t measure poverty correctly, then using a simple number isn’t useful to generalize and make conclusions. And I certainly wouldn’t want to target interventions.

There’s a reason why it’s complicated.

> If I can’t measure poverty correctly, then using a simple number isn’t useful to generalize

Why not? It can be good enough to identify a pattern to focus more precise study on.

"I'd rather not understand this at all if we can't have a perfect understanding" is a harsh and anti-science stance on this imo.

More like “I’d rather have minimally acceptable understanding than incorrect and harmful understanding.”

The reason is there are many confounding variables so measuring poverty incorrectly and reaching a wrong conclusion can focus resources toward people who don’t need it (eg, single people making half the median wage who are not in poverty).

I think sometimes you don’t have a choice. But in this case, there is a more accurate measure to use, so not using it makes conclusions less helpful.

I think claiming things as “anti-science” is a gatekeeping function that is counterproductive. Especially when people don’t understand statistical significance and are trying to make conclusions that aren’t accurate. I don’t think things are “anti-science” or “pro-science” as these are imprecise and meaningless statements.

I’m not sure what you mean by saying anti-science. But I think it’s not logical to assume something that is minimally effective is striving for perfection and something that isn’t significant is good enough.

The federal "poverty line" definition is notoriously arbitrary and based on a model of household expenses that hasn't been valid for at least a generation. It's almost completely useless for anything except punitively restricting access to aid.

> Also interesting that the issues here would still be categorized as caused by poverty rather than the pandemic and our pandemic response.

This is what they're doing. "The pandemic" is a human social and political phenomenon. So is poverty. There's not going to be a clear line between the two either broadly or in many specific cases. Someone who caught covid at work knowing they were immunocompromised but needed the money, did they die of pandemic or poverty? Someone who died of preventable covid complications but couldn't access adequate healthcare because of money?

Approaching it as "pandemic, mediated by poverty" is a useful lens and people are also studying it that way. But "poverty, mediated by pandemic" is also useful and in a different way and that's what this one went with.

> Someone who caught covid at work knowing they were immunocompromised but needed the money, did they did our pandemic or poverty?

When looking at aggregate statistics one of examples can't be considered, the data simply isn't there. Also for this example I believe the answer would be that the fictious person would have died with covid and poverty, notof either one.

> Someone who died of preventable covid complications but couldn't access adequate Healthcare because of money?

Similar issues here. The study want designed to look into these concerns and the data just isn't there. In this example it's also be impossible to know if the person does of preventable complications, at best you could say they died with complications that are often treatable or preventable.

My point with regards to this study was simply that they are looking at people who died of drug overdoses, weather exposure, hunger, etc and rolling that up to say they died from poverty as those issues are often linked to poverty. I'm arguing that they would have to make a similar decision for any poverty caused by the pandemic and pandemic response, they wouldn't have been poor if not for the pandemic just like the study is assuming someone wouldn't have died of not for being below their definition of poverty.

If a study gets to pick and choose whether they want to pin the blame on covid or poverty then the data really is useless. Solid data backed up by empirical evidence showing causation, which is what this study attempts to do, is directional and can't be flipped around. It's worth noting here the article is calling poverty a cause of death, not a contributing factor. They are making the claim that it is directly causal, in which case the order isn't reversable.

This paper is not on sci-hub. :(

The abstract sounds correlational.

The quotes from the researchers at the top of the article say explicitly that it's casual. The later parts of the article describing the paper go back to sounding correlational.

I would expect there to be enough shared causes to make it rather a pain to untangle.

"Poverty, which the study defined as less than half the median U.S. income"

I wonder how much of this can be attributed to medical bankruptcy. If you cannot afford insurance, get injured, can't afford treatment...pretty straightforward doom loop to an early grave

Democracy, the poor can't afford

>I wonder how much of this can be attributed to medical bankruptcy.

Only 4% of US bankruptcies are because of medical bills <https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0...>. A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause. The biggest cause of bankruptcies is lack of income, which health insurance doesn't affect.

91% of Americans have medical insurance, whether through their employers, or government programs like Medicare/Medicaid. That's compared to 95-97% in other developed countries because there are always some people who fall through cracks, like (say) a Canadian who doesn't get a new provincial health care card after moving, or a German who neglects to buy into a new sickness fund after changing careers. The only such systems with actual 100% (or as close to it as possible) coverage is something like the UK NHS, which does not have a requirement to show a membership card (because, well, there isn't one) to receive treatment.

There are things I'd certainly improve about the US system—decoupling primary healthcare coverage from employment, for one—but the way people online ~~lie~~ exaggerate it's not surprising that so many non-Americans believe that every American is one hangnail away from bankruptcy.

PS - Obamacare did not greatly expand coverage. 85% of Americans had medical insurance pre-Obamacare.

The extremes are what people will talk about most, for sure; I lived that experience in a state where medicaid wasn't expanded and have trouble shutting up about it. Most everyone around me avoided that experience, almost everyone in my social circles.

States without medicaid expansion are very rough. Most people don't realize that ACA plans have a minimum income to qualify. Medicaid was supposed to take over below that income level. If you're in Florida or Texas and are an adult who isn't currently pregnant (or have a legally declared disability), and make less than 150% of the federal poverty limit, there is literally no insurance you can get except paying full retail price for a private plan (which would consume about 1/2 of your income in premiums and deductibles).

You describe precicely my situation after being laid off last year

$1600 a month for health insurance

That's absolutely indecent. Has this been solved by now? Are you managing? (email in profile if you want)

Thanks. I'll email

The details vary but if you don’t earn much you usually qualify for additional cost-sharing reductions which cuts the costs of insurance plans under the ACA substantially.

As long as you make at minimum 150% of the federal poverty line. Under that, you don't even qualify for ACA at all. States are supposed to provide Medicaid under that line but some have refused.

That 91% figure comes with a big caveat: it's the percentage of people who reported they had health insurance at any point during the year. So if you had coverage on January 1st but lost coverage on January 2nd and never resumed coverage for the year - you're still considered part of that 91%.

There's also the challenge that not all coverage is equal here. The ACA (and certain follow-up legislation) set some baseline, and states may also have their own minimum coverage criteria, but it can vary wildly. The ACA's biggest impact was mandating coverage for common-but-critical things like childbirth etc.

Source: https://www.census.gov/library/publications/2022/demo/p60-27...

Obama are became Trumpcare became Bidencare. Obama may have put his name on that shit sandwich of a plan, but both parties have been in charge since and no one has explained how the bastardized middle ground of not quite socialized Healthcare is the right answer, or proposed a proper fix to the broken attempt at a crawl/walk/run strategy.

> the way people online ~~lie~~ exaggerate it's not surprising that so many non-Americans believe that every American is one hangnail away from bankruptcy.

People exaggerating online certainly don't cause more confusion than the routine lies of medical providers, sending bills with completely-fictitious humongous numbers claiming to be the price. And then even if you do have "insurance" (which isn't actually insurance, but rather more of an anticompetitive protection racket), the provider and the "insurance" company both continue to keep the actual prices obfuscated with those fictitious numbers and a whole bunch of "adjustments", rather than ever just plainly stating prices.

There are certainly a lot of overly simplistic narratives about US healthcare, like every political topic. But the entire system is death by a thousand cuts of patently absurd behavior (like the above), that would be plainly illegal with any sort of sane regulation. Like imagine going to the grocery store, paying the cashier, and then getting shaken down months later by food distributors claiming that you only paid the cashier to bag and that you owe them money.

> the provider and the "insurance" company both continue to keep the actual prices obfuscated with those fictitious numbers and a whole bunch of "adjustments", rather than ever just plainly stating prices.

That's the name of the game, not unique to USofA. Once you have majority/monopoly payer (be that private insurance or tax-supported state health fund) it becomes a game of cat and mouse. Health providers try to extract as much per case as possible, insurance providers try to cut per-case payment to the minimum. Inflating list prices on provider's end, establishing various per-item limits and per-case adjustments on payer's end are the low hanging fruit towards the goal. State insurance systems just have this less visible as the patient is usually not involved in the invoicing process, but nevertheless it is there.

The sad reality is that there is very little to none incentive for list prices to remain low or reflective of actual cost.

> Only 4% of US bankruptcies are because of medical bills

That's not 'only'.

In quite a few other countries that percentage is zero.

Such as?

In Canada, with universal healthcare that cost $0 at the point of care, bankruptcies due to health issues is actually pretty high (15% for seniors).

Why? Because a big driver of medical bankruptcy is not the medical costs, but the fact you can no longer work and any assistance you get doesn't cover your cost of living.

That's already indirect rather than direct. Canada has a lot of problems, this is one of them. On paper everything works but in practice lots of people fall through the cracks, I've seen this up closed (lived in Canada for many years).

yeah although medical does contribute, I bet the bulk of it is consumer debt. There are trillions and trillions made by industries pushing on people shit they can't afford. After you max out on iphones and other stupid shit, you either have to put up with snowballing interest (forget the principal) or declare bankruptcy. The latest innovation is bnpl where people buy food, groceries on credit :facepalm:

Health insurance is a nebulous concept.My basic plan for instance doesn't cover dentistry so I got a 500 euro bill.

This inspired me to donate to an NGO that provides oral healthcare for the poor.

Considering 41 out of 50 states have expanded Medicaid to include people up to include adults up to 138% of federal poverty level, and Medicaid has very low out of pocket costs, I'd argue that the very poor actually have better medical insurance than middle class people in the US.

Outrageous, runaway medical costs are the cause. Not poverty.

Seems really hard to peg any one factor as "the cause". How did you land on runaway medical costs?

i think its a bit strange to blame medical costs, such as expensive treatment X for serious disease/injury that didnt exist 30 years ago, as the cause of someones death, who would have been dead without that treatment.

the money involved in healthcare does bring up some interesting thoughts.

i remember hearing that the "war on poverty" didnt impact poverty rates because govt guidlines dont factor in gov't social services such as $ amount of medicaid recieved, food stamps, etc.

so really the cause of death should include poverty + depending on X govt services, not either or

I don't see how they made the connection to poverty and mortality. I'm sure there is one, but the fact the article didn't point out the specific cause and effect is disappointing.

The onset of the coronavirus pandemic in 2020 brought about a sharp increase in U.S. poverty as millions of people got sick, were thrown out of work, and lost health insurance.

Are they trying to say that people died during Covid because an increase in poverty and that poverty was the reason for the increase in deaths? What about Covid?

But federal aid initiatives enacted in response to the public health and economic crisis—from stimulus checks to boosted unemployment benefits to enhanced nutrition assistance—ultimately led to a significant drop in poverty, further bolstering the case that "poverty is a policy choice."

Poverty is certainly policy choice to a degree.

> Poverty is certainly policy choice to a degree.

Housing is probably the biggest cause of poverty directly influenced by (existing) policy.

Zoning alone could result in plenty of reduction in inequality among other stuff like reducing NIMBY power.

I'm curious if now that we have a mountain of half empty offices which don't freely compete with residential development if the implications of zoning is even worse than before. Previously the primary argument was low-density suburban zoning acts in conflict to the free market (https://www.amazon.com/Zoned-Out-Jonathan-Levine/dp/19331151...) which besides giant skyscrapers was the only openly tolerated housing development for the past n* decades.

It would be nice to have a social safety net in regards to rent/mortgage. I'm not sure how to implement it though. The eviction moratorium played a big part in lack of homelessness during covid. The only problem is the government made property owners financially responsible for it. I'm not sure if they ever got compensated.

Meh we need supply not bandaid'ing high rent costs. The housing crisis goes well beyond the homeless (which get the bulk of the attention, if not adequate solutions), which only ever results in half-baked subsidies or forcing skyscrapers to add a small amount of low income options. While the drumbeat of ever increasing housing costs continues.

Housing needs radical reform. There isn't a lack of capital to build this stuff. We don't need government to put up a bunch of money. The second they make building possible, in the places/ways the market demands, there will be a flood of new development which will directly benefit the low end of the market by not making tiny houses cost $1M and low-density suburban housing the only alternative.

This is a bit confusing. Everybody dies, poor or not. Poor people are not over-represented in death statistics.

A meaningful measure would have been "being poor means dying X years earlier, give or take Y, compared to median wealth".

There's probably lots of data everywhere but here is "Poverty rates in OECD countries as of 2021" to compare where the US sits against other countries:

https://www.statista.com/statistics/233910/poverty-rates-in-...

They're probably using the ~6.85$ a day ("upper middle income poverty line") https://ourworldindata.org/poverty

I’m very skeptical of this. I have been homeless in metro America and a huge number of the people I was homeless with (as well as their families) would be no healthier with an additional $10k, $20k, $30k etc., a year.

Activists like to claim that “food deserts” are a supply side phenomena but I promise they exist due to a lack of demand for the food those in suburbs or luxury high-rises prefer. A larger budget just means the vast majority of these people will purchase Pizza Hut instead of Caseys/7-Eleven.

This is a shocking and sad statistic. Poverty is a preventable and curable condition, yet it kills millions of people every year. We need to address the root causes of poverty and inequality, such as unfair trade policies, corruption, exploitation, discrimination, etc. We also need to invest more in social protection, health care, education, and other basic services for the poor. Poverty is not inevitable. It is a choice.

I thought root cause of inequality is genetics and sexual reproduction.

I became disabled in 2018. I have accumulated 5 figures in debt already since even while being on Cobra and now Medicare. This is criminal.

Just don’t pay it. I wish I had been told this instead of flushing thousands upon thousands down the toilet in a futile attempt to keep the balance at $0. The system is designed to be adversarial and your best tactic as a patient is to delay, delay, delay and fight every single bill.

I have had seven operations for Crohns, a back surgery, and treatment for ongoing Leukaemia. I have lived in a half dozen different jurisdictions for health care and I’m only alive thanks to the excellence of the US medical system. Doesn’t make the financial side of it any less onerous, sadly.

What happens to the typical person’s healthcare costs when some people who consume extremely expensive treatments” just don’t pay”? What is the equilibrium here?

Most likely nothing, medical expenses are no where near at-cost like they should be. Even assuming that they go up, you can't expect anyone not to "consume" medical care. I'm not going to deny someone treatment because it might cost me a few more pennies or dollars, that would be comically villainous.

The equilibrium would be treating medical care as a public good just like highways or firefighting, but insurance companies and hospital-owning equity firms actively expend resources to prevent that.

If they were at cost, nobody would invest in healthcare and you'd die undiagnosed of something as trivial as pneumonia.

Also firefighters will charge you for a callout.

Doesn’t that depend on the city you live in?

The economics of the system are so convoluted I'm not sure if anyone can answer. There is no equilibrium.

But maybe finding the breaking point would push us to untangle the perverse economics of our current system and do what every other developed country in the world does (and spends less money doing, all total)

Not sure but none of the medical care I’ve received should actually be expensive. Every medicine I’ve ever been prescribed is generic, every emergency procedure would have been covered by state funds had I not paid.

The fact that very few institutions pursue me at all for these supposedly owed funds tells me none of them are close to teetering on the brink of insolvency.

As someone who as also had healthcare in single payer (the NHS) and presently pays both the government (Estonia) and private insurance (Estonia and US), I have zero problem paying for the general upkeep of the country’s medical system.

I simply refuse to believe that because some life saving care was “out of network” the cost to treat me actually ballooned from thousands to millions. It’s an artifact of a system that’s not designed for uninsured/underinsured participants.

The idea in socialised medicine is that we all share the burden- each to their own ability.

Like any other income based tax.

I imagine at some point UCLA or Cedar Sinai will just stop offering me services? I need to see nutrition but it isn’t covered by medicare so it is $600 for an appointment but it is integral to my actual condition so it seems like I am being screwed over. I cannot pay that and also eat, which sorta defeats the purpose of staying alive. I cannot do food banks because I have a mast cell disorder and what I can actually safely eat is complicated. I don’t have a clue how to navigate this.

I have an ER bill of $100k+ owed to Stanford for the better part of a decade (amongst an huge number of other more recent bills) and they still see me for regular booked appointments and ERs.

It works less well for specialist offices owned by doctors themselves but I’ve found the large hospitals are disinclined to outright deny service, for a multitude of reasons.

Re: nutrition, is there a clinic outside your normal network that might offer that? You may have to wait longer but I’ve been able to see no-cost specialists in St Louis, Chicago and the Bay Area through various neighborhood clinics. I’m always happy to help too - feel free to drop me an email and I can connect you to some resources in your area.

Most importantly, best of luck with all of this.

I appreciate that.

The nutritionist I saw is highly recommended because she has dealt with patients like me before. Is there some kind of bill deferring thing I could do in this situation?

Have you talked to her finance team? Is she part of the major hospital networks you already visit?

If that $600 isn’t your copay but instead the whole cost out-of-network, there is almost certainly a way to get that put on a 12 month payment plan or something similar.

Why are you not on Medicaid?

Poverty is known to directly attack the liver particularly hard.

What's next? Being human is the #1 cause of death?

The study is paywalled but it looks like poverty is just correlated with death. The most likely explanation is that they have a common cause.

In studies that can differentiate between environmental and genetic causes, longevity has some genetic influence but no or very little influence from poverty. For example, from [1]:

> The heritability of longevity was estimated to be 0.26 for males and 0.23 for females. [...] There is no evidence for an impact of shared (family) environment.

In this context, "shared family environment" encompasses everything in the environment that is shared between children in the same family, including income.

Another study [2] shows that longevity has substantial genetic cause:

> Half of the variation in susceptibility to mortality is genetic: findings from Swedish twin survival data

Note that these two studies only include childhood poverty. What about adult poverty? From [3]:

> While we find some evidence that permanent income shocks lead to poorer health behaviour, we find no evidence that it affects directly any health measures. Despite sizable shocks to income at the cohort level during our period of analysis, which can be empirically linked to changes in consumption expenditures, we fail to find any changes in (cohort) health, even if we allow those shocks to affect health with a lag.

Note that this is health, not mortality, but they're related. It suggests that the stronger underlying cause is, in the paper's terms, "underlying factors" such as genetics, innate ability, or childhood poverty. Childhood poverty we already know from behavior genetics is not causal.

There's other evidence out there along similar lines. If the new paper used a research design that could actually determine causality, or could at least rule out some ways in which a common cause would explain the data, it would be more interesting.

[1] Herskind AM, McGue M, Holm NV, Sørensen TI, Harvald B, Vaupel JW. The heritability of human longevity: a population-based study of 2872 Danish twin pairs born 1870-1900. Hum Genet. 1996 Mar;97(3):319-23. doi: 10.1007/BF02185763. PMID: 8786073.

[2] Yashin AI, Iachine IA, Harris JR. Half of the variation in susceptibility to mortality is genetic: findings from Swedish twin survival data. Behav Genet. 1999 Jan;29(1):11-9. doi: 10.1023/a:1021481620934. PMID: 10371754.

[3] Adda, Jérôme, et al. “THE IMPACT OF INCOME SHOCKS ON HEALTH: EVIDENCE FROM COHORT DATA.” Journal of the European Economic Association, vol. 7, no. 6, 2009, pp. 1361–99. JSTOR, http://www.jstor.org/stable/40601206. Accessed 22 May 2023.

Living is the 1st Leading Cause of Death in the US

Research published this week estimated that life was linked to at least 100% of the deaths in the United States in 2019 among people aged 0 or older, making living the nation's number one leading mortality driver that year.

3rd iteration of that joke on this thread.

JFK on, inter alia, poverty (extended dance mix): http://blogfiles.wfmu.org/KF/0510/jfk/05_-_Sing_Along_With_J...

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