Life-course inheritances, wealth and health: examining causal effects in 11 European countries

Mauricio Avendano Pabon, Erasmus Medical Centre, Rotterdam and Harvard School of Public Health
Maria Glymour, Harvard School of Public Health

Wealth is strongly associated with health, but recent evidence suggests that this association might not reflect causality from wealth to health. We examine the impact of life-course inheritances and inheritance wealth on health in 11 Western European countries. Data came from the Survey of Health, Ageing and Retirement in Europe (SHARE). In 2004, we recorded retrospective data on all received inheritances and life-course diagnosed diseases over the life-course in a sample of 26,425 individuals in 11 countries. First, we used Cox Proportional hazard and logistic regression models to examine inheritance effects on health. Secondly, we used inheritances as instrumental variable (IV) to examine effects of accumulated wealth on health across Northern, Central and Southern Europe. 24% of Europeans reported receiving at least one inheritance of 5,000 euro or larger, but this ranged from 18% in Austria to 49% in Spain and Switzerland. Controlling for background characteristics, inheritances were associated with a substantial and significant reduction in the risk of heart disease, stroke, hypertension, diabetes, cancer and lung disease. However, among heirs, there was no association between inheritance amount and disease risk. Life-course inheritances were strongly associated with accumulated wealth. In IV models, wealth was associated with significantly reduced risks of all diseases. However, among heirs, there was no association between wealth and risk of most conditions. Wealth and inheritance effects were weaker in Southern Europe for some outcomes, but there was overall little evidence of differential effects across European regions. Our findings suggest that inheritances and wealth are significantly associated with chronic disease risk, but among heirs, these associations are not observed. Findings might reflect the positive health effects of inheritances and wealth, but they may also reflect unobserved heterogeneity between heirs and non-heirs, contradicting the hypothesis of causal effects.