Abstract
Poor health and unhealthy lifestyles are substantially more prevalent among individuals with low income than among individuals with high income, but the underlying mechanisms are not well understood. To evaluate whether changes to unearned wealth from lotteries are associated with long-term health behaviors and overall health. In this quasi-experimental cohort study, 4820 participants (aged 18-70 years at the time of winning) in 3 Swedish lotteries were surveyed from September 1, 2016, to November 11, 2016, between 5 and 22 years after a lottery event. Outcomes of participants in the same lottery who were randomly assigned prizes of different magnitudes by the lotteries but were ex ante identical in terms of their probability of winning different prizes were compared. Data were analyzed from December 22, 2016, to November 21, 2019. Lottery prizes ranged from $0 for nonwinning players to $1.6 million. Four lifestyle factors (smoking, alcohol consumption, physical activity, and a healthy diet index) and 2 measures of overall health (subjective health and an index of total health derived from responses to questions about 35 health conditions). The survey was returned by 3344 of 4820 individuals (69%; 1722 [51.5%] male), which corresponded to 3362 observations. The mean (SD) age was 48 (11.8) years in the year of the lottery win and 60 (11.0) years at the time of the survey. There were no statistically significant associations between prize amount won and any of the 6 long-term health outcomes. Estimated associations expressed in SD units per $100 000 won were as follows: smoking (-0.006, 95% CI, -0.038 to 0.026); alcohol consumption (0.003, 95% CI, -0.027 to 0.033); physical activity (0.001, 95% CI, -0.029 to 0.032); dietary quality (-0.007, 95% CI, -0.040 to 0.026); subjective health (0.013, 95% CI, -0.017 to 0.043); and index of total health (-0.003, 95% CI, -0.033 to 0.027). In this study of Swedish lottery players, unearned wealth from random lottery prize winnings was not associated with subsequent healthy lifestyle factors or overall health. The findings suggest that large, random transfers of unearned wealth are unlikely to be associated with large, long-term changes in health habits or overall health.
Highlights
Research has documented a positive association between income and health.[1]
In this study of Swedish lottery players, unearned wealth from random lottery prize winnings was not associated with subsequent healthy lifestyle factors or overall health
The findings suggest that large, random transfers of unearned wealth are unlikely to be associated with large, long-term changes in health habits or overall health
Summary
Research has documented a positive association between income and health.[1]. The positive association, sometimes characterized as the income-health gradient, has been found across a wide range of institutional settings, including developed countries with extensive welfare systems. A Swedish study found that men in the lowest income decile were 5 times more likely to report being in ill health compared with men in the top decile.[2] There is broad agreement that systematic differences in lifestyle and behavioral factors contribute to the income-health gradient.[3] Research has consistently found that individuals with higher incomes are less likely to engage in health-impairing behaviors, such as smoking, and more likely to engage in health-promoting behaviors, such as maintaining a healthy diet or exercising regularly.[4,5,6,7]. It has been hypothesized that income is associated with health behaviors because it is costly to maintain a healthy lifestyle.[8] Some epidemiologists have proposed that the higher prevalence of healthimpairing behaviors, such as smoking, in low-income households is a behavioral response to the stress caused by limited material resources.[9,10,11]
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