Wealth gap in aging: the poorest 60-year-olds in England walked as slowly as the richest 75-year-olds

One of the quickest tests of how well someone is aging needs only a stopwatch and a few meters of floor. How fast a person walks at their usual pace reflects their heart, lungs, muscles, joints and nerves at once, and it is closely tied to how long they will live.

By that test, money buys time. In a study of more than 31,000 older adults, a 60-year-old with the least wealth had the same gait speed as a 75-year-old with the most wealth in England. In Canada the gap was nine years. The research, led by Stephanie Schrempft of Geneva University Hospitals and published in PLOS Medicine in August, is one of the first to follow how physical decline unfolds over time by wealth in two countries side by side, and its most striking result is how different those two countries look.

Why researchers measure physical function to track aging

Counting diseases is a poor guide to how someone is getting on in later life. Two patients with the same diagnoses can differ enormously in whether they can climb stairs, carry shopping or live alone. Physical function tries to capture that directly.

The study used two kinds of measure. Nurses and trained staff timed participants walking a short course, measured the strength of their grip, timed five rises from a chair without using their arms and tested their lungs. Interviewers also asked about hearing and eyesight and about difficulty with everyday tasks. The basic list was dressing, walking across a room, bathing or showering, eating, getting in or out of bed, and using the toilet. A second list covered the more demanding business of running a household: shopping, cooking, taking medicines, managing money.

Walking speed has the strongest record as a marker of general health. A 2011 analysis in JAMA led by Stephanie Studenski of the University of Pittsburgh pooled nine cohorts and 34,485 older adults, and gait speed was associated with survival in all studies. Among 75-year-old men, the predicted chance of surviving ten years ranged from 19% for the slowest walkers to 87% for the fastest.

How wealth and physical aging were compared in England and Canada

The data came from two national projects built for this kind of question. England’s long-running panel study of people aged 50 and over contributed 8,511 participants, and the Canadian Longitudinal Study on Aging contributed 22,605. All were aged 50 to 85 at the start, around 2012, and were retested several times over the following nine to eleven years.

Wealth, as opposed to income, was the yardstick. For those who have stopped working, savings and assets say more about material security than a monthly figure does. Participants in each country were divided into four groups by household wealth. In England the lowest group averaged about £22,000 and the highest more than £1.4 million.

The researchers modeled how each measure changed with age in each wealth group, taking account of sex and ethnicity. To express the differences in a form that means something, they calculated what they call years of functioning lost: the age at which the wealthiest group reaches the level of function that the least wealthy group already has at 60.

How large was the wealth gap in physical aging?

In both countries, less wealth was associated with a poorer level of functioning across outcomes. The least wealthy walked more slowly, gripped more weakly, took longer to stand, had weaker lungs, rated their hearing and sight as worse and reported more trouble with daily tasks.

The size of the gap is where the countries parted. In England, the poorest 60-year-olds had the walking speed of the richest 75-year-olds, a gap of 15 years. Their difficulty with basic daily activities matched that of the richest 80-year-olds, a gap of 20 years, and for household tasks the gap was 16 years. In Canada the equivalent gaps were nine, nine and six years.

The differences also widened with time in the ways that matter most for independence. In both countries, adults with the least wealth lost the ability to manage daily and household activities faster as they aged than those with the most. In England their mobility declined faster too.

One finding ran the other way. The wealthiest English participants lost walking speed slightly faster than the poorest, and the wealthiest Canadians slowed more on the chair test. The authors read this as a late catching-up, since anyone who starts from a higher level has further to fall once the physical decline of old age sets in. Even so, they note of the English walkers that the level of gait speed did not reach that of those with the least wealth.

Sex mattered as well. The paper reports that women with the least wealth experienced greater difficulties with daily and household tasks and with mobility than men in the same wealth group, though their lung function was better.

Illness, weight and smoking did not explain the wealth gap in function

An obvious explanation is that the less wealthy are sicker and have had harder habits to break. The team tested it by adding each person’s number of chronic conditions, their weight, smoking and drinking, and then their marital status, social isolation and loneliness.

The gaps shrank and remained. In the authors’ summary, the associations were attenuated but generally persisted after additional adjustment for the number of chronic conditions, weight status and the other factors. Whatever separates rich and poor in later life, most of it is not captured by a list of diagnoses and risk behaviors.

That leaves less visible influences. The authors suggest several that their data could not test, among them access to timely, high-quality, and continuous healthcare, rehabilitation, and assistive support, the wear of physically demanding or hazardous work over a lifetime, and housing. They also point out that both England and Canada permit supplementary private insurance, so the wealthy in either country may get treatment and physiotherapy sooner.

Why would England’s wealth gap in aging be wider than Canada’s?

The two countries were chosen because they are alike. Both fund health care from taxation, both have similar income inequality and similar life expectancy. The authors say they were surprised to find England’s gradient roughly twice as steep on several measures.

“What struck us most was how much larger the wealth gaps were in England than in Canada,” Silvia Stringhini, the study’s senior author, said in a statement released by the journal. “Our study cannot tell us exactly why two countries with universal healthcare and similar income inequality diverge so much, but it tells us the difference is real and substantial.”

The paper offers candidates without choosing among them: differences in the quality of and access to health care, in social welfare, in housing and in everyday health habits. It notes that international rankings of healthy life expectancy and of health care quality place Canada somewhat above the United Kingdom.

Some of the difference may be an artifact of measurement. Wealth was recorded in more detail in England, as a continuous figure net of debt, while the Canadian survey asked for savings and investments in four broad bands. A blunter measure sorts people less precisely, which could make the Canadian groups look more alike than they are. The walking tests were not identical either, with two short walks timed in England and one slightly longer walk in Canada, and the Canadian participants all lived within reach of a study clinic.

Earlier studies of wealth and physical function found the same gradient

That the poor age faster physically is well established, and Stringhini has measured it before. In 2018 Stringhini led a study in The BMJ of 109,107 adults in 24 countries, which found that men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status. That study classed people by occupation, a coarser divide than comparing the top and bottom quarters of wealth, which may be why its gap is smaller. It also found that years of functioning lost were greater than years of life lost to low social position: disadvantage costs more in capability than in survival.

An American team has compared England with the United States on the same theme. Lena Makaroun and colleagues reported in JAMA Internal Medicine in 2017 that among English adults in their late fifties and early sixties, 42% of the poorest fifth developed a disability within ten years, against 17% of the richest fifth. The American gradient was similar. Their conclusion was blunt: access to health care may not attenuate wealth-associated disparities in older adults.

The new study adds the dimension of time, by following the same people for a decade, and the Canadian comparison, which shows that the size of the gap is not fixed.

Limits of the England and Canada wealth comparison

The study describes an association. Wealth was recorded once, at the start, and the analysis cannot rule out traffic in the other direction, in which poor health in midlife ends a career early and drains savings.

Not everyone stayed in the study. Between 70% and 80% of participants had follow-up measurements, and those who drop out of aging studies tend to be the frailest, which could hide some of the decline. Childhood circumstances and use of private health care were not available. The authors also acknowledge the underrepresentation of nonwhite participants in both cohorts, at about 4% in England and 3% in Canada, which limits what the results say about more diverse populations.

What the wealth gap in aging asks of policy

The authors address governments more than individuals. They argue that policy on aging has concentrated on survival and disease and ought to give equal weight to function and independence, and they list measures they consider plausible: more adequate pensions, lower cost barriers to rehabilitation and long-term care, better housing standards and stronger protection of health at work. None of these was tested in the study.

Schrempft described the stakes this way: “By following older adults in England and Canada side by side, we could see that being less wealthy does not just mean worse health on average, it means losing physical independence faster as you age.”

Why a 60-year-old’s walking speed should depend so much more on wealth in England than in Canada is the question the study raises and leaves open.