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Do socioeconomic inequalities in pain, psychological distress and oral health increase or decrease over the life course? Evidence from Sweden over 43 years of follow-up
  1. Roger Keller Celeste1,2,
  2. Johan Fritzell2
  1. 1 Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
  2. 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
  1. Correspondence to Associate Professor Roger Keller Celeste, Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre - RS 90035-003, Brazil; roger.keller{at}ufrgs.br

Abstract

Background Inequalities over the life course may increase due to accumulation of disadvantage or may decrease because ageing can work as a leveller. We report how absolute and relative socioeconomic inequalities in musculoskeletal pain, oral health and psychological distress evolve with ageing.

Methods Data were combined from two nationally representative Swedish panel studies: the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Individuals were followed up to 43 years in six waves (1968, 1974, 1981, 1991/1992, 2000/2002, 2010/2011) from five cohorts: 1906–1915 (n=899), 1925–1934 (n=906), 1944–1953 (n=1154), 1957–1966 (n=923) and 1970–1981 (n=1199). The participants were 15–62 years at baseline. Three self-reported outcomes were measured as dichotomous variables: teeth not in good conditions, psychological distress and musculoskeletal pain. The fixed-income groups were: (A) never poor and (B) poor at least once in life. The relationship between ageing and the outcomes was smoothed with locally weighted ordinary least squares, and the relative and absolute gaps were calculated with Poisson regression using generalised estimating equations.

Results All outcomes were associated with ageing, birth cohort, sex and being poor at least once in live. Absolute inequalities increased up to the age of 45–64 years, and then they decreased. Relative inequalities were large already in individuals aged 15–25 years, showing a declining trend over the life course. Selective mortality did not change the results. The socioeconomic gap was larger for current poverty than for being poor at least once in life.

Conclusion Inequalities persist into very old age, though they are more salient in midlife for all three outcomes observed.

  • chronic di
  • cohort studies
  • gerontology
  • health inequalities
  • life course eidemiology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Licence for Publication The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non-exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd and its Licensees to permit this article (if accepted) to be published in Journal of Epidemiology & Community Health and any other BMJPGL products to exploit all subsidiary rights, as set  out in our licence Unable to resolve custom email tag and the Corresponding Author accepts and understands that any supply made under these terms is made by BMJPGL to the Corresponding Author.

  • RKC and JF contributed equally.

  • Contributors Both authors participated in concept and design. JF participated in acquisition data and RKC in data analysis. Both authors participated in interpretation, writing the manuscript and approved the final version.

  • Funding This work was supported by grants from FORTE (2012:1950 and 2016-07206), NordForsk (74637) and the Swedish Foundation for International Cooperation in Research and Higher Education (STINT BR2013-5215). RKC holds PQ-2 fellowship from CNPq (BrazilianResearch Council).

  • Competing interests None declared.

  • Ethics approval Project was approved by the Ethics Institutional Review Board of the Statistics Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.