The longevity gap between rich and poor: Fact or Fiction?

The basic premise of the movie Elysium is that Earth 150 years from now has been decimated by Global Warming, overpopulation, disease, and poverty. The wealthy 1% has fled to a Utopian existence on a vast space station orbiting Earth appropriately called Elysium. On Elysium, there are medical pods (Figure 2) that eradicate all diseases so that the inhabitants can lead almost immortal lives. Meanwhile back on Earth, the 99% toil in a Mad Max like struggle in which the remnants of law-and-order are imposed by Corporations exploiting the labor of the poor masses who are overseen by robotic security forces. Hospitals are poorly equipped, understaffed, and do not have access to the magical medical pods, and so the inhabitants on Earth lead short and brutish lives.

Is this storyline Hollywood imagination gone amuck or prophecy of what is to come?

According to a recent article from Aeon magazine with the lede "The longevity gap: Will new drugs mean the rich live to 120 and the poor die at 60?", this future scenario is not too far-fetched.

The article notes that there is already a big gap in longevity between the rich and poor in America:

"The life expectancy gap between the affluent and the poor and working class in the US, for instance, now clocks in at 12.2 years. College-educated white men can expect to live to age 80, while counterparts without a high-school diploma die by age 67. White women with a college degree have a life expectancy of nearly 84, compared with uneducated women, who live to 73.

And these disparities are widening. The lives of white, female high-school dropouts are now five years shorter than those of previous generations of women without a high-school degree, while white men without a high-school diploma live three years fewer than their counterparts did 18 years ago, according to a 2012 study from Health Affairs."

A longevity gap of 12.2 years between rich and poor -- Wow. Furthermore, as I have blogged about previously, what is even more frightening is that for poor whites life expectancy is actually declining:

"Yesterday I read a troubling article in the New York Times that described a disturbing trend in which the life expectancy of white men and women without a high school diploma has declined dramatically over the last two decades; women by 5 years (from 78 to 73) and men by 3 years (from 70 to 67). By contrast, the life expectancy of Hispanics or blacks without a high school degree has not declined, but risen over the same time period (Hispanic women is ~ 82 years). Finally, the life span of all whites has also increased because of a significant increase in the longevity of those with higher education."

Given all of the advances in modern medicine, it is unacceptable that life expectancy for any group should drop. This is an issue of sociology, economics, and politics along with medicine.

What about the wealthy 1%, will their lifespan continue to increase to 120 and beyond? Is it possible to develop medical pods or miracle drugs that can extend life almost indefinitely?

Currently, the number of centenarians (people who live to 100) is only about 20 in 100,000 in the U.S. The oldest person ever lived to 122. So an average lifespan of 120 even for the wealthy is not going to happen overnight.

If I may speculate, modern medicine can help people live to 80 or 90 but beyond that other factors such as good genes and healthy living practices will be crucial. There is strong evidence for a genetic component to longevity; one example is that siblings of centenarians tend to live longer.

Indeed, in a study published in The Lancet, researchers compared the lifespan of siblings of centenarians to a control group (i.e. siblings of non-centenarians). The results shown in Figure 1 indicate that the risk ratio of survival was 1.09 in the 65-69 age group, 1.8 in the 75-78 age group, 3.49 in the 80-84 age group, and 4.02 in the 90-94 age group. In other words, centenarian siblings were 4 times more likely to reach age 90 than non-centenarian siblings. The rise in the risk ratio of survival with increasing age indicates that genetics becomes more important at older ages. In other words, modern medicine can help everyone survive to approximately 70-74, and then after that the "good genes" helped centenarian siblings survive to a greater and greater extent as they became older.

Figure 1. Risk ratio of survival for siblings of centenarians versus siblings of (random) 73-year-olds (reproduced from The Lancet).

Adopting healthy practices (e.g. healthy diet and exercise) are often very difficult, but can be achieved through effort and discipline. Replicating the beneficial effects of "good genes" through medical treatments to slow aging is a much greater challenge; for example, we don't know for sure what these "longevity" genes are in humans. Finally, it is important to appreciate that there will always be a tradeoff with respect to living longer.

For example in a previous post titled "The Ultimate Tradeoff" I described a select group of individuals who did indeed live much longer than the typical person:

"This past week, an interesting study was published in Current Biology (a prestigious journal) which showed that eunuchs, castrated males, lived longer than normal males during ancient times in Korea. In fact the difference was quite significant (from Reuters):

"Researchers looking at the court of the Chosun Dynasty found eunuchs lived to 70 on average, or 14 to 19 years longer than "intact" men of similar socio-economic status. Three of the 81 eunuchs studied lived to 100 or more, giving the group a centenarian rate some 130 times that in developed nations today."

So if you are a guy and you want to live to 100 perhaps you should just cut off your testicles (the sooner the better). Would you make that tradeoff? Or perhaps it is better just to wait for a magical medical pod?

Figure 2. Magical medical pod from the movie Elysium.