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

Across today’s developed world, there is a clear mortality gradient by socioeconomic status at 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 less developed. While some studies based on cross-sectional data support this view, others based on longitudinal data find 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 only after 1950 for women and after 1970 for men starting in ages 30-59 continuing in the subsequent periods in ages 60-89. Since the mortality gradient emerged during the time that 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.