Abstract
The structure of social welfare policy has neglected a growing and increasingly economically marginalized segment of the American population-the lower middle class, a large group who are ineligible for many need-based social services. We examined 20-year time trends in physical well-being, mental well-being, and functional well-being by levels of household income. Our descriptive study used data from the Behavioral Risk Factor Surveillance System and is representative of the population of the United States, ages 40 to 74, from 2003 to 2022 (n = 5 308 256). We found dramatic and consistent differences in trends in well-being by income category. While well-being generally got worse over the 20-year period for all ages, the declines were most pronounced for lower-middle-income households for individuals age 50 to 59. These differential trends by income were similar for all 3 of the measures of well-being we examined, but were most different by income level for physical well-being and functional well-being. No major trends or levels were explained by race, body mass index, or smoking. If the observed trends persist, the current age 50-59-year-old lower-middle-income population will enter retirement ages with substantially worse well-being than previous generations.