Low-income people have heightened heart attack death risk in 6 world health systems

Health disparities persist even with universal health care, strong social safety nets

Two horizontal red lines punctuated with jagged peaks representing a heart beat on an electrocardiogram
Image: mr.suphachai praserdumrongchai/iStock/Getty Images Plus

At a glance:

  • Low-income patients have mortality rates 10 to 20 percent greater than their high-income peers.
  • High-income individuals were more likely to receive life-saving treatments compared to low-income individuals.
  • Results challenge the belief that income-based disparities are a uniquely American phenomenon.
  • The study found that the poverty penalty seems consistent across countries.


Despite vastly different health care systems, low-income patients across six different countries have mortality rates 10 to 20 percent greater than their high-income peers, according to a new study led by researchers from Harvard Medical School, the University of Texas Medical Branch, Galveston, ICES (formerly the Institute for Clinical Evaluative Sciences), and other international collaborators.

The findings suggest that income-based disparities are present even in countries with universal health care and robust social services, the researchers said.

The paper, published in the journal JAMA, was a project of the International Health System Research Collaborative, an effort dedicated to understanding the trade-offs inherent in different nations’ approaches to delivering health care.

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“A country’s health care system can impact treatment and outcomes for specific health conditions, like cardiovascular disease,” said Bruce Landon, professor of health care policy in the Blavatnik Institute at HMS.

“We wanted to explore whether the poorer outcomes that have been observed in lower-income Americans relative to higher-income Americans were reduced in countries with universal health insurance. We found that high-income individuals had better survival rates and were more likely to receive life-saving treatments compared to low-income individuals, regardless of their country of residence or type of health system,” he said.