Socioeconomic inequality in life expectancy is increasing in Denmark and the rest of the world, but new research shows that is this is not because innovation in healthcare has greater benefits for more-affluent people than less-affluent people. A researcher involved in the study proposes a specific reason why innovation in healthcare provides greater increases in life expectancy for more-affluent people than for less-affluent people.
The gap in life expectancy is widening.
From 2001 to 2014, the inequality in life expectancy between the most affluent people (the top third) and the least affluent people (the bottom third) increased by 0.9 years in Denmark and 1.7 years in the United States.
This increase in inequality in life expectancy is in addition to an already large difference. In 2014, the least affluent third of people in Denmark lived an average of 75 years versus 84 years for the most affluent third.
One hypothesis could be that this increasing inequality could result from new technology and new treatments primarily benefitting affluent people, but a new study provides evidence that rejects this interpretation.
“In the past 30 years, for example, cardiovascular disease treatment has improved considerably, leading to a large decline in cardiovascular disease mortality. One hypothesis could be that new treatments benefit the most affluent people more than the least affluent people, but we found that this is not the case. Other mechanisms result in new innovation not having the same effect on the life expectancy of the least affluent people,” explains a researcher behind the study, Benjamin Ly Serena, Assistant Professor, Department of Economics, Copenhagen Business School, Denmark.
The research has been published in The Review of Economic and Statistics.
Mathematical modelling on the effects of innovation in healthcare
The researchers examined data from Denmark and the United States to determine why socioeconomic inequality in life expectancy continues to increase.
They used mathematical decomposition: mathematically isolating the hypothetical effects of various hypotheses to determine whether the increasing inequality is driven by innovation in healthcare benefitting the most affluent people more than the least affluent people.
The researchers mathematically created a 40-year-old individual and then examined how innovation in healthcare would affect that person’s life expectancy depending on their individual socioeconomic status.
This enabled the researchers to answer the question of whether access to innovation in healthcare has the same effect on life expectancy for more- or less-affluent people or whether less-affluent people do not benefit equally from innovation in healthcare because their already reduced life expectancy means that they do not live long enough to benefit from the innovation.
More- and less-affluent people benefit equally from innovation in healthcare
Most surprisingly, the results of the mathematical modelling showed that more- and less- affluent people benefit equally from innovation in healthcare.
For example, the innovation of improving treatment for people with blood clots leads to equal survival up to one year after the blood clot for the two socioeconomic groups. So the innovation in healthcare does not inherently lead to inequality, but what happens afterwards does.
“Innovation in healthcare does not mean becoming better at preventing more-affluent people from dying than less-affluent people. The numbers are the same. However, saving an affluent person from dying leads to many years of life afterwards, whereas many less-affluent people have other comorbidities that kill them. Even if they have been saved from the effects of a blood clot, they die instead from lung cancer, diabetes, alcohol-related diseases or other cardiovascular diseases, and this means that the innovation has less effect on their life expectancy than on the life expectancy of a more-affluent person,” says Benjamin Ly Serena.
Dying from other causes
Benjamin Ly Serena elaborates that benefitting from innovation in healthcare requires living long enough for it to have an effect.
“Two things determine why less-affluent people do not benefit as much from innovation in healthcare as more-affluent people: they do not live long enough to benefit from any given innovation, and, if they live long enough, they die shortly after a new innovation saves their life,” he says.
Broadly speaking, if a lifelong smoker dies from lung cancer at the age of 50 years, inventing a new and improved cardiovascular disease treatment does not affect their life expectancy.
Conversely, people who enjoy a healthy lifestyle and work that is less harmful to health, which applies to more-affluent people, can benefit from the innovation, and this will increase their life expectancy.
“Our results show that all the increasing inequality in life expectancy in Denmark results from the fact that the least affluent third of the population do not live long enough for them to benefit to the same extent from innovation in healthcare. In the United States, this explains most of the difference,” adds Benjamin Ly Serena.
However, he also points out that based solely on survival within the first year after illness, innovation in healthcare actually provides greater benefits to less-affluent people than to more-affluent people.
Researchers not worried
According to Benjamin Ly Serena, these results are surprising and may affect the understanding of why socioeconomic inequality in life expectancy continues to increase.
“This may not be as concerning as we had previously thought. If this difference were driven by discrimination or access to innovation in healthcare, this would indicate a structural problem. But we found that innovation in healthcare benefits everyone, but other mechanisms mean that innovation in healthcare provides greater increases in the life expectancy of more-affluent people than of less-affluent people,” he says.
He elaborates that lifestyle appears to differentiate the effect of innovation in healthcare between socioeconomic strata. This is where intervention is required to reduce socioeconomic inequality in life expectancy and not access to innovation in healthcare.
“Innovation in healthcare will always make existing inequality more apparent. However, this innovation does not worsen the health of less-affluent people. It saves lives for everyone, but the effect on remaining life expectancy differs,” concludes Benjamin Ly Serena.
