Socioeconomic Differences in Pathways to Death in Sweden

Marcus Ebeling , Karolinska Institutet
Mats Talbäck, Karolinska Institutet
Anna C. Meyer, Institute of Environmental Medicine, Karolinska institutet
Karin Modig, Karolinska Institutet

Research on socioeconomic inequalities in health often focuses on why some groups show greater improvements than others. The fact that we all face death and often a period of severe health decline at the end of life is overlooked. As a result, little is known about socioeconomic differences in end-of-life trajectories. Based on Swedish register data, we will fill this knowledge gap and analyze socioeconomic differences in pathways to death for all deaths at ages 60+ (approximately 90% of all deaths in Sweden each year) in the years 2018 to 2022. We will apply structural equation models to identify the latent types of end-of-life trajectories based on monthly information on health status, prescribed medications, monthly hours of elderly care, and other indicators that cover the last five years of life. In a second step, we will assess the socioeconomic differences within and across the end-of-life trajectory types. We will use disposable household-adjusted income as a measure for socioeconomic status. Preliminary results based only on the last year of life suggest a similar distribution of trajectory types across income quintiles but marked differences in their timing over age. By extending the observation period to the last five years of life, we however observe that people in the highest income quintile die in worse health than those in lower income quintiles. The preliminary results invite the hypothesis that socioeconomic differences in mortality at older ages are partly due to a slower dying process in the higher socioeconomic groups compared to the lower socioeconomic groups.

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 Presented in Session 64. Wellbeing in Older Age