A common assumption in the social stratification literature is that the lion’s share of people reaches occupational maturity quite early in working life, i.e., they end up in an occupation/class position and stay there. The conventional view is that career maturity is reached around the age of 35. By using Swedish longitudinal occupational biographies across six birth cohorts from 1925 to 1984, this study challenges this view. Our findings reveal substantial career transitions throughout working life, an increase across cohorts, and a wide variation in the age of the last class transition. This suggests that careers are not in general static positions from a certain age, but fluctuate over time. There are signs of a general slowing down of career transitions across working lives, but this comes later in life and to a smaller extent than expected. These findings suggest that research often based on cross sectional data, e.g. studies on intergenerational mobility and class differences in health, need to incorporate career mobility data. More research is needed to illuminate if the results of Sweden, in terms of a low and decreasing level of occupational maturity can be replicated in other countries.

Background

The sibling bond is often the longest relationship in an individual’s life, spanning both good and bad times. Focusing on the latter, we investigated whether a cancer diagnosis in one adult sibling is predictive of psychiatric illness in the other, and if any such effect differs according the ‘sociodemographic closeness’ between the siblings in terms of sex, age, education, marital status and residence.

Methods

We used hospital records to identify psychiatric diagnoses (2005–2019) in a Swedish total-population cohort born in 1953, and cancer diagnoses (2005–2017) in their full siblings. By means of emulated clinical trials, the cohort member’s risk of a diagnosis within two years following a first exposure (or non-exposure) to a sibling’s cancer was analyzed through Cox regression.

Results

Exposed cohort members had a higher risk of psychiatric diagnosis than unexposed (HR = 1.15; CI: 1.08–1.23), with men displaying a higher risk (1.19; CI: 1.09–1.31) than women (HR = 1.11; CI: 1.01–1.22). Sub-analyses of the exposed group showed that women with a cancer-stricken sister had a higher risk of adverse psychiatric outcomes (HR = 1.31; CI: 1.07–1.61) than women with a cancer-stricken brother. Furthermore, unmarried cohort members ran a higher risk, both when the cancer-stricken sibling was married (HR = 2.03; CI: 1.67–2.46) and unmarried (HR = 2.61; CI: 2.16–3.15), than in cases where both siblings were married. No corresponding difference were detected for ‘closeness’ in age, education and residence.

Conclusions

In line with theories of linked lives, our findings suggest that negative events in one sibling’s life tend to ‘spill over’ on the other sibling’s wellbeing, at least during the 15-year-long period leading up to retirement age.

Socioeconomic inequality in health among women is often referred to as smaller than health inequality among men. However, we know less about differences in health between men and women within the same socioeconomic groups. In this article the lack of attention to potential socioeconomic variation in gender health inequality is argued as unfortunate, as it can obscure how mechanisms, such as e.g. working conditions, affect gendered health within specific groups. Drawing on the nationally representative Swedish Level of Living survey (LNU), class/gender interactions as well as class-separate linear probability models are estimated to explore relationships between working conditions and health among men and women with the same occupational class positions. Results show that, although class is not a large explanatory factor for general gender differences in health, there are varying within-class differences between men and women in working conditions, that can contribute to the understanding of within-class gender differences in health. This highlights that, when targeting causes of gender health inequality, it is important to consider not only what class means for women as well as for men, but also what gender means within specific classes.

This thesis examines two aspects of social inequalities in health with three empirical studies that are based on the Swedish Level of Living survey (LNU): The relationship between accumulated occupational class positions during adulthood and health and the class-specific nature of gender differences in health. Previous research continuously finds that there are health differences by class and gender, but less is known about the extent to which accumulated class experiences in adulthood are related to health or how gender differences vary by class. The overall conclusion in this thesis is that occupational class experiences matters for health, both as historical and current experiences. Furthermore, the results highlight the importance of taking class into consideration when examining health differences between men and women, as the mechanisms that underlie the gender gaps in health are not necessarily the same for all classes. The studies can be outlined as:

Study I: Class differences in working conditions is a mechanism that underlies class inequalities in health. The working class is generally more exposed to adverse working environments than non-manual employees, and when the wear and tear of these conditions accumulate over time, the length of this exposure may contribute to class inequalities in health. Thereby, accumulated time in the working class is studied as a partial explanation for class differences in health. The results suggest that the duration of time in the working class is related to a higher probability of less than good self-rated general health (SRH), given current class position. This association was also found among individuals who were no longer in working class positions and thus show that duration of experience matters, both as current and past experience.

Study II: The study addresses the research gap of class-specificity in gender health inequality and seeks to further disentangle class and gender by studying gender gaps separately by class. The results show that there are class-specific gender gaps for both SRH and musculoskeletal pain, while the gender gap in psychiatric distress appears to be more general across class. Working conditions do not explain the between-class differences in gender gaps but contribute to specific gender differences in health within classes.

Study III: The labour market has changed over time and has “upgraded” the class structure while at the same time the share of women in paid employment has increased. Therefore, female health may be increasingly influenced by occupational factors, such as working conditions. This study explores the class-specific nature of gender differences and investigates musculoskeletal pain and working conditions among employed men and women within classes during a time-period that spanned more than 30 years. There were class-specific gender gaps in health throughout the period. The gender gap has increased more, and is wider, among non-manual employees compared to the working classes. This development could not be explained by changes in working conditions.

Previous research has shown a social gradient in health with better health for people in more advantaged positions in society. This research has mainly been on the relationship between current position and health, or social position in childhood and health, but less is known about the potential accumulative impact of positions held in adulthood. In this paper I use the economic activity histories from the Swedish Level of Living survey to examine the relationship between accumulated occupational class positions and health. Step-wise linear probability models are used to investigate how to best capture the potential association between class experience and self-rated health (SRH), and whether the effect of current class is modified when measures of accumulated class are included. I then further test the potentially lasting association between previous exposure to the health risk of working class by analysing only individuals currently in higher or intermediate level service class; the classes under least exposure. I find a positive association between accumulated experiences of working class and less than good SRH. Furthermore, even for employees currently in non-manual positions the risk for less than good SRH increases with each added year of previous experience within working class. This suggests that the social gradient can be both accumulative and lasting, and that more information on the mechanisms of health disparities can be found by taking detailed information on peoples' pasts into account. Although gender differences in health are not a focus in this paper, results also indicate that the influence of class experiences on health might differ between men and women.