Aims: Social inequalities in mortality persist or even increase in high-income countries. Most evidence is based on a period approach to measuring mortality – that is, data from individuals born decades apart. A cohort approach, however, provides complementary insights using data from individuals who grow up and age under similar social and institutional arrangements. This study compares income inequalities in cohort life expectancy in two Swedish cohorts, one born before and one born after the expansion of the welfare state. Methods: Data on individuals born in Sweden in 1922–1926 and 1951–1955 were obtained from total population registries. These data were linked to individual disposable income from 1970 and 1999 and mortality between 50 and 61 years of age in 1972–1987 and 2001–2016, respectively. We calculated cohort temporary life expectancies in the two cohorts by income and gender. Results: Life expectancy, income, and income inequalities in life expectancy increased between the two cohorts, for both men and women. Women born in 1922–1926 had modest income differences in life expectancy, but pronounced differences emerged in the cohort born in 1951–1955. Men with low incomes born in 1951–1955 had roughly similar life expectancy as those with low incomes born in 1922–1926. Conclusions: Compared with a period approach to life expectancy trends, the cohort approach highlights the stagnation of mortality at the lowest income groups for men and the rapid emergence of a mortality gradient for women. Future research on health inequalities in welfare states should consider underlying factors both from a cohort and period perspective.

Although both childhood and adult economic conditions have been found to be associated with mortality, independently or in combination with each other, less is known about the role of intermediate factors between these two life stages. This study explores the pathways between childhood economic conditions and adult mortality by taking personal attributes as well as adult socioeconomic career into consideration. Further, we investigate the role of intergenerational income mobility for adult mortality. We used data from a prospective cohort study of individuals that were born in 1953 and residing in Stockholm, Sweden, in 1963 who were followed for mortality between 2002 and 2021 (n = 11,325). We fit Cox proportional hazards models to assess the association of parental income, cognitive ability, social skills, educational attainment, occupational status, and adult income with mortality. The income mobility is operationalized as the interaction between parental and adult income. Our results show that the association between parental income and adult mortality is modest and largely operates through cognitive ability and adult educational attainment. However, our results do not provide support for there being an effect of intergenerational income mobility on adult mortality. In a Swedish cohort who grew up in a comparatively egalitarian society during the 1950s and 1960s, childhood economic conditions were found to play a distinct but relatively small role for later mortality.

The theoretical link between intergenerational social mobility and mental health has long been explored in the social sciences. Declining social mobility in high-income countries alongside rising mental health concerns have reignited interest in this research area. Sweden, while experiencing similar trends, remains a country known for its high social mobility. To investigate the relationship between social mobility and mental health, we used psychotropic drug dispensation as a proxy for mental health problems. We analyzed survey and register data of a 1953 Stockholm cohort (n=11,199), followed up for psychotropic drug dispensation between ages 52-66. We measure social mobility using parental income at ages 10 and 17 and adult income between ages 37-48. Using diagonal reference models, we analyzed the association between income mobility and psychotropic drug use, stratified by gender. Adjustments were made for growing up in a single-parent household, cognitive ability, social skills, marital status, and previous hospitalization. An income gradient in psychotropic drug dispensation for the stable income group was observed, with a more pronounced pattern among men than women. Net of social origin and destination, income mobility was related to psychotropic drug dispensation among men, but not women. Downward mobility increased, while upward mobility decreased the probability of dispensing psychotropic drugs among men (0.046, p=0.029 vs. -0.047, p<0.020). These results remained robust after adjustments (0.048, p=0.010 vs. -0.044, p<0.017). Our findings suggest that income mobility is associated with middle-aged men’s use of psychotropic drugs. Further research is needed to confirm these results in different contexts and age groups.