When Did the Health Gradient Emerge? Social Class and Adult Mortality in Southern Sweden, 1813–2015

Tommy Bengtsson, Martin Dribe, Jonas Helgertz

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Across today’s developed world, there is a clear mortality gradient by socioeconomic status for all ages. It is often taken for granted that this gradient was as strong—or even stronger—in the past when social transfers were rudimentary and health care systems were less developed. Some studies based on cross-sectional data have supported this view, but others based on longitudinal data found that this was not the case. If there was no gradient in the past, when did it emerge? To answer this question, we examine social class differences in adult mortality for men and women in southern Sweden over a 200-year period, using unique individual-level register data. We find a systematic class gradient in adult mortality emerging at ages 30–59 only after 1950 for women and after 1970 for men, and in subsequent periods also observable for ages 60–89. Given that the mortality gradient emerged when Sweden transitioned into a modern welfare state with substantial social transfers and a universal health care system, this finding points to lifestyle and psychosocial factors as likely determinants.

Original languageEnglish (US)
Pages (from-to)953-977
Number of pages25
JournalDemography
Volume57
Issue number3
DOIs
StatePublished - Jun 1 2020

Bibliographical note

Funding Information:
Open access funding provided by Lund University. This study is part of the research program ?The Rise and Fall of the Industrial City: Landskrona Population Study,? funded by the Swedish Foundation for Humanities and Social Sciences (RJ) and supported by the LONGPOP project, which has received funding from the European Union?s Horizon 2020 research and innovation program under the Marie Sk?odowska-Curie Grant Agreement No. 676060. (Disclaimer: this publication reflects only the authors? view, and the Agency is not responsible for any use that may be made of the information it contains.) Dr. Helgertz also gratefully acknowledges support from the Minnesota Population Center (P2C HD041023) funded through a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD). We thank participants at the IUSSP seminar ?Linking Past to Present: Long-Term Perspectives on Micro-Level Demographic Processes? at Reitaku University, Kashiwa, Japan, December 9?10, 2016; participants at the Population Association of America annual meeting, April 2017; and five anonymous referees for their comments.

Funding Information:
Open access funding provided by Lund University. This study is part of the research program “The Rise and Fall of the Industrial City: Landskrona Population Study,” funded by the Swedish Foundation for Humanities and Social Sciences (RJ) and supported by the LONGPOP project, which has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie Grant Agreement No. 676060. (Disclaimer: this publication reflects only the authors’ view, and the Agency is not responsible for any use that may be made of the information it contains.) Dr. Helgertz also gratefully acknowledges support from the Minnesota Population Center (P2C HD041023) funded through a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD). We thank participants at the IUSSP seminar “Linking Past to Present: Long-Term Perspectives on Micro-Level Demographic Processes” at Reitaku University, Kashiwa, Japan, December 9–10, 2016; participants at the Population Association of America annual meeting, April 2017; and five anonymous referees for their comments.

Publisher Copyright:
© 2020, The Author(s).

Keywords

  • Adult mortality
  • Class gradient
  • Mortality differences
  • Sweden
  • Twentieth century

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