Changes in life expectancy and lifespan variability by income quartiles in four Nordic countries: a study based on nationwide register data

Abstract

ObjectivesLevels, trends or changes in socioeconomic mortality differentials are typically described in terms of means, for example, life expectancies, but studies have suggested that there also are systematic social disparities in the dispersion around those means, in other words there are inequalities in lifespan variation. This study investigates changes in income inequalities in mean and distributional measures of mortality in Denmark, Finland, Norway, and Sweden over two decades.DesignNationwide register-based study.SettingThe Danish, Finnish, Norwegian and Swedish populations aged 30 years or over in 1997 and 2017.Main outcome measuresIncome-specific changes in life expectancy, lifespan variation and the contribution of ‘early’ and ‘late’ deaths to increasing life expectancy.ResultsIncreases in life expectancy has taken place in all four countries, but there are systematic differences across income groups. In general, the largest gains in life expectancy were observed in Denmark, and the smallest increase among low-income women in Sweden and Norway. Overall, life expectancy increased and lifespan variation decreased with increasing income level. These differences grew larger over time. In all countries, a marked postponement of early deaths led to a compression of mortality in the top three income quartiles for both genders. This did not occur for the lowest income quartile.ConclusionIncreasing life expectancy is typically accompanied by postponement of early deaths and reduction of lifespan inequality in the higher-income groups. However, Nordic welfare societies are challenged by the fact that postponing premature deaths among people in the lowest-income groups is not taking place.

Socioeconomic inequalities in survival to retirement age: a register-based analysis

“…Overall, these results clearly indicate that mortality improvements were far from equally distributed across SES groups over the course of the study period. Overall, the results of this study are consistent with others that find widening social inequalities in life expectancy in Denmark, as well as in other European countries (Brønnum-Hansen et al, 2021;Brønnum-Hansen & Baadsgaard, 2012;Huisman et al, 2004;Mackenbach et al, 2003Mackenbach et al, , 2017. We also find parallels with the body of literature that suggests recent pension reforms will inherently benefit those of higher SES, such that they will receive greater benefits in absolute terms than those of lower SES, even as those of lower SES will receive greater benefits in relative terms (Alvarez et al, 2021;Brønnum-Hansen et al, 2017Brønnum-Hansen & Baadsgaard, 2007.…”

“…Socioeconomic inequalities in mortality persist among both older men and older women, and in some countries, these inequalities were found to be of a similar magnitude to those of the middle aged (Huisman et al, 2004). Improvements in life expectancy and lifespan variability have been found to differ across SES groups, with lower SES groups experiencing little improvement in life expectancy and no improvements in lifespan variability (Brønnum-Hansen et al, 2021). Analyzing the individual dimensions of SES shows a similar trend.…”

“…Increasing mortality disparities across SES groups suggest indexing the pension age to total life expectancy is inherently unfair to those in lower SES groups, as mortality improvements for these groups are negligible or nonexistent compared to higher SES groups (Brønnum-Hansen et al, 2021).…”

Why we should monitor disparities in old-age mortality with the modal age at death

“…In Finland, variability in age at death for the manual classes increased since the 1970s, therefore suggesting an expansion rather than a compression of mortality, but declined for the non-manual classes. Similarly diverging trends over the entire adult age range have played out among income group in other Nordic countries [ 24 ], by educational groups in Spain [ 25 ], and the USA [ 26 ], and between quintiles of area-level deprivation in Scotland [ 27 ].…”

Decomposing Lifespan Variance: A Distributional Approach

“…Life expectancy and lifespan inequality differ by gender, education, occupation, income, race/ethnicity, geographic location, etc. For instance, lower socioeconomic status has been consistently found to be associated with lower life expectancy and higher lifespan inequality (Brønnum-Hansen et al 2021;Permanyer et al 2018;Sasson 2016;van Raalte et al 2014). What is more worrisome is that lifespan inequality has been increasing or stagnating for lower socioeconomic groups while decreasing for higher socioeconomic groups (van Raalte et al 2018).…”