Published on: Nov 10, 2025
Adults who experience poverty—whether consistently or intermittently—across two decades from young to mid-adulthood face a significantly higher risk of premature death than those who never experience poverty, according to new research led by Columbia University’s Mailman School of Public Health. A related study by the same team suggests that increasing unsecured debt, such as credit card debt not backed by assets, may be one mechanism connecting early-life financial hardship to a higher mortality risk. Both studies appear in The Lancet Public Health.
Using data from the National Longitudinal Survey of Youth 1979 (NLSY79), the poverty study tracked participants’ income between 1985 and 2004 (ages 23–42) and monitored mortality outcomes through 2019, when participants were aged 53–62—well below the average life expectancy for those birth years. Adults who spent more years living in poverty had more than twice the risk of premature death compared with those who were never poor.
Greater cumulative exposure to poverty during early and mid-adulthood is associated with an increased risk of premature mortality, said Adina Zeki Al Hazzouri, PhD, assistant professor of Epidemiology at Columbia Mailman School and senior author of the study. By focusing on income at a single time point, previous studies may have overlooked the complex and changing nature of poverty and its long-term health effects.The findings highlight the need for interventions that reduce poverty during critical life stages, especially among vulnerable populations.
In the second study, Zeki Al Hazzouri and colleagues examined data from 6,954 NLSY79 participants to evaluate how unsecured debt patterns over 20 years of early adulthood relate to mortality in midlife (ages 41–62). They found that individuals whose unsecured debt increased over time had an 89% higher risk of premature death compared to those whose debt remained consistently low.
This kind of debt carries high interest rates, doesn’t contribute to wealth, and can be both stressful and financially draining, said Zeki Al Hazzouri. It’s important to recognize it as a social determinant of health.
Together, the two studies underscore that poverty and financial strain are powerful determinants of long-term health outcomes, including early mortality. They also highlight that financial well-being is dynamic and its impact on health may change over time.
An accompanying commentary in The Lancet Public Health by Harvard Medical School and CUNY professors David Himmelstein and Steffie Woolhandler notes a clear dose–response relationship between the duration of poverty or unsecured debt and the risk of premature death. They suggest these findings help explain why poverty in the U.S. is particularly harmful to health and why individuals in lower wealth groups are less likely to move up economically compared to those in other wealthy countries—largely due to weaker social and healthcare supports. They call for public policies that prevent and mitigate the consequences of financial burden or otherwise deepen poverty as an essential part of public health strategy.
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