Poverty has emerged worldwide as a major social determinant of health. According to Healthy People 2030, people living in poverty are less likely to have access to health care, nutritious food, stable housing, and opportunities for physical activity, and are more likely to die from preventable diseases. A new study in the June issue of JAMA Internal Medicine now ranks poverty as the fourth leading cause of death in the United States.

The study by researchers at the University of California Riverside set out to examine the relationship between current poverty (poverty in any one year) and cumulative poverty (poverty during some part of the previous 10 years) and mortality. The research team utilized data from two ongoing and well-established longitudinal data sets-the University of Michigan's Panel Study of Income Dynamics and Ohio State University's Cross-National Equivalent File-for the years 1997 to 2019. Poverty was defined relatively as less than 50% of median income. The data were adjusted for household size, and for potential health confounders including overweight or obesity, smoking, and acute or chronic diseases. Overall, 6.5% of U.S. deaths were associated with current poverty, and 10.5% with cumulative poverty.

Compared with other risk factors or causes of death, both current and cumulative poverty were associated with greater mortality in the United States than diabetes, stroke, Alzheimer disease, or accidents. Only cancer, heart disease, or smoking contributed to more deaths than cumulative poverty. In 2019, current poverty was associated with 10 times as many U.S. deaths as homicide, 4.7 times as many deaths as firearms, 3.9 times as many deaths as suicide, and 2.6 times as many deaths as drug overdose.

The data analysis ended before the start of the COVID-19 pandemic. The authors note that the higher rate of poverty in the United States compared with other wealthy countries may be a reason for higher COVID-19 mortality rates per capita. An estimated 15.1% of the U.S. population lives in poverty, compared with 11.2% in the U.K., 8.6% in Canada, and 6.5% in Denmark, according to 2021 data from the Organization for Economic Cooperation and Development. The association of poverty with mortality may also help to explain lower life expectancy in the United States compared with some other high-income countries.

These data suggest that poverty is a major risk factor for death in the United States-and something nurses and other clinicians should consider in their interactions with patients. Because early mortality also has economic consequences for society, the researchers recommend that benefit-cost calculations of efforts to reduce poverty should include the economic benefits of lower mortality.-Betsy Todd, MPH, RN