Abstract
Importance: 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. Objective: To evaluate whether changes to unearned wealth from lotteries are associated with long-term health behaviors and overall health. Design, Setting, and Participants: 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. Exposures: Lottery prizes ranged from $0 for nonwinning players to $1.6 million. Main Outcomes and Measures: 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). Results: 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). Conclusions and Relevance: 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.