As keen investors, we read with interest the study by Schwartz et al showing that the 2008 stock market crash was not associated with an increase in total or cardiac death. Ma et al previously reported an increased mortality in Chinese investors during periods of high stock market volatility, although an increased mortality is seen during times of large market gains and at times of losses.

It is speculated that this difference relates to the fact that Los Angeles–based investors frequently hire investment managers to deal with their portfolios, whereas Chinese investors manage their own stocks in real time and develop the consequent anxiety and stress.

Although an increase in cardiovascular mortality has been shown to relate to acutely stressful situations, there is a large difference in the death rates in cardiovascular disease between China and the United States. The age-standardized death rates for cardiovascular diseases per 100,000 in China are 311.5 for men and 259.6 for women. In the United States, the rats are 190.5 for men and 122.0 for women. Perhaps the discrepancy in results between these 2 studies can be explained, at least in part, by the ability of the different health care systems to treat investors with cardiovascular disease.

The stock market crash of 2008 did not occur until late September/early October 2008. The Los Angeles–based investors relying on their monthly statements to follow the markets may not have been informed of any losses until November 2008. The study by Schwartz et al was completed shortly afterward at the end of 2008, although the stock market continued to fall significantly until well into 2009. Therefore, the study covers only a short period when investors were exposed to the reality of a stock market crash. This may also explain the discrepancy in observations between Schwartz et al and Ma et al.

It is assumed by Schwartz et al that a stock market crash is a stressful situation for investors. Although this may be true, some investors may have taken up “short positions” and thus profited from any market fall, so this assumption is not universally correct.