Two studies in the November issue of The Lancet Public Health used the NLSY79 cohort to examine links between long-term poverty, rising unsecured debt and premature mortality. People always in poverty had a 2.5-fold higher risk of early death; those often or sometimes in poverty faced 53% and 10% higher risks, respectively. A separate analysis found an 89% greater risk of premature death for individuals whose unsecured debt increased over time. Commentators note that limited social mobility and weak safety nets in the U.S. likely magnify these harms.
Prolonged Poverty and Rising Unsecured Debt Tied to Higher Risk of Premature Death, Large U.S. Studies Find
Two studies in the November issue of The Lancet Public Health used the NLSY79 cohort to examine links between long-term poverty, rising unsecured debt and premature mortality. People always in poverty had a 2.5-fold higher risk of early death; those often or sometimes in poverty faced 53% and 10% higher risks, respectively. A separate analysis found an 89% greater risk of premature death for individuals whose unsecured debt increased over time. Commentators note that limited social mobility and weak safety nets in the U.S. likely magnify these harms.
11:20 PM, 11/13/2025Health
Studies link long-term poverty and growing unsecured debt to earlier deaths in U.S. adults
Two new analyses published in the November issue of The Lancet Public Health report that extended exposure to poverty and increasing unsecured debt during early adulthood are associated with substantially higher odds of premature mortality.
Both studies used data from the National Longitudinal Survey of Youth 1979 (NLSY79), which tracks people born in the United States between 1957 and 1964. Researchers followed participants for roughly two decades to map patterns of economic hardship and subsequent mortality.
Long-term poverty: a clear dose–response effect
In the first study (more than 5,600 participants), researchers grouped people by how often they lived at poverty-level family income over the follow-up: never, sometimes, often, or always in poverty. Compared with those never impoverished, the analysis found:
- Always in poverty: a 2.5-fold higher risk of premature death
- Often in poverty: a 53% higher risk
- Sometimes in poverty: a 10% higher risk
The authors describe a dose–response relationship: the greater the cumulative exposure to poverty across emerging and established adulthood, the higher the risk for premature mortality.
Rising unsecured debt linked to higher mortality
The second study analyzed nearly 7,000 participants for trajectories of unsecured debt — liabilities such as credit card balances and many student loans that are not backed by an asset. Unsecured debt typically carries higher interest rates and does not build wealth, and it can be a persistent source of financial stress.
People whose unsecured debt increased over time had an 89% greater risk of premature death compared with those whose unsecured debt remained consistently low.
“This category of debt carries higher interest rates and does not contribute to wealth accumulation,” said senior author Adina Zeki Al Hazzouri, an associate professor of epidemiology at Columbia University's Mailman School of Public Health. She noted that rising unsecured debt may reflect deeper resource constraints and greater chronic stress.
Context and interpretation
In an accompanying editorial, Dr. David Himmelstein and Dr. Steffie Woolhandler (CUNY–Hunter College) suggested the observed dose–response link between poverty, indebtedness and mortality may help explain why poverty appears to harm health more severely in the United States than in other wealthy nations. They highlight two contributing factors: limited upward mobility for those in the lowest wealth quintiles and comparatively weak social and medical safety nets that amplify the health consequences of economic hardship.
These findings do not prove causation but strengthen evidence that sustained economic strain and mounting unsecured debt are important social determinants of health with long-term consequences.
More information: The American Academy of Family Physicians (AAFP) provides resources on poverty and health.