Adults who experience poverty-level incomes—whether continuously or intermittently from young adulthood into midlife—face a substantially higher risk of premature death than those who are never poor, according to new research led by the Columbia University Mailman School of Public Health. A companion study by the same team identifies rising unsecured debt, including credit card debt not tied to assets, as a likely pathway linking early financial strain to higher mortality risk. Both studies appear in The Lancet Public Health and offer new insights into the long-term health consequences of economic hardship during the formative adult years.
The researchers analysed data from the National Longitudinal Survey of Youth 1979 (NLSY79), tracking participants’ income between 1985 and 2004, when they were aged twenty-three to forty-two, and then following mortality outcomes through 2019, as participants reached ages fifty-three to sixty-two. This period is still well below average life expectancy for their birth cohorts, making the findings particularly striking. The study showed that individuals who spent more years living in poverty had more than twice the rate of premature mortality compared with those who never experienced poverty. The results emphasise the cumulative and dynamic nature of financial adversity, countering earlier research that relied on single-point income measurements and therefore may have underestimated the impact of recurrent or short-term poverty.
Senior author Adina Zeki Al Hazzouri, PhD, explained that early and mid-adulthood are critical periods in which exposure to financial instability can shape long-term health. She noted that poverty’s fluctuating patterns deserve greater attention, as even intermittent hardship appears to leave a lasting imprint on mortality risk. The authors argue that interventions to reduce poverty during these key life stages—particularly for vulnerable populations—are essential. However, more research is needed to determine which policies most effectively support long-term health.
In the second study, Zeki Al Hazzouri and colleagues examined unsecured debt trajectories among 6,954 NLSY79 participants over the same twenty-year span. They found that individuals whose unsecured debt increased steadily over time faced an eighty-nine per cent higher risk of dying in midlife compared with those whose debt remained consistently low. The researchers highlight that unsecured debt is especially burdensome: it often carries high interest rates, does not contribute to wealth accumulation, and may signal broader resource limitations. As such, it may exert significant stress, making it an essential but often overlooked social determinant of health.
Together, the two studies demonstrate that experiences of poverty and financial strain are potent predictors of premature mortality. They also underscore that economic well-being is not static but shifts over the life course, with specific periods appearing more consequential for health outcomes. By examining long-term patterns rather than single snapshots, the research offers a clearer understanding of how economic disadvantage accumulates and affects physical well-being.
An accompanying commentary by Harvard Medical School and CUNY scholars David Himmelstein and Steffie Woolhandler highlights the observed dose–response relationship: the more years spent in poverty or burdened by unsecured debt, the greater the risk of early death. They argue that these findings may help explain why poverty is particularly damaging to health in the United States, where weaker social and medical supports can amplify its effects. The commentators call for policies that actively prevent and reduce financial hardship, framing such measures as central to improving public health and reducing inequities.
More information: Calvin L Colvin et al, Investigating associations between long-term poverty exposure and premature mortality: evidence from the National Longitudinal Survey of Youth 1979 prospective cohort, The Lancet Public Health. DOI: 10.1016/S2468-2667(25)00227-0
Journal information: The Lancet Public Health Provided by Columbia University’s Mailman School of Public Health
