Has it always paid to be rich? Income and cause-specific mortality in southern Sweden 1905-2014.

Socio-economic differences in mortality are among the most pervasive characteristics of Western societies. While the mortality gradient by income is well established for the period after 1970, knowledge about the origins of this gradient is still rudimentary. We analyse the association between income and cause-specific adult mortality during the period 1905-2014 in an area of southern Sweden, using competing-risk hazard models with individual-level longitudinal data for over 2.2 million person-years and over 35,000 deaths. We find that the present-day income gradient in adult mortality emerged only in the period after the Second World War and did so for the leading causes of death and for men and women largely simultaneously.

Childhood neighborhoods and cause-specific adult mortality in Sweden 1939-2015.

The socioeconomic health gradient has widened in recent decades. We study how childhood socioeconomic neighborhood conditions influence gender- and cause-specific adult mortality. Using uniquely detailed geocoded longitudinal microdata for a Swedish town (1939-1967), with a follow-up in national registers (1968-2015), we apply Cox proportional hazards models and estimate individual neighborhoods at the address-level. We find that childhood neighborhood social class has a lasting influence on male adult mortality (ages 40-69), even when adjusting for class position, class origin, neighborhood physical attributes and school districts. This impact was particularly pronounced for preventable causes of death, pointing to lifestyle and behavioral factors as important mechanisms.

Maternal height and child health and schooling in sub-Saharan Africa: Decomposition and heterogeneity.

Maternal height is associated with mortality and anthropometry in low-and-middle-income countries. This paper explored residual associations and potential underlying mechanisms linking maternal height to several child outcomes using regression models with neighborhood and half-sibling fixed effects and Gelbach decomposition on 108 Demographic and Health Surveys from 37 sub-Saharan African countries. When adjusting for time of birth, twinning, sex, and survey, a single z-score (6.5 cm) increase in mother's height was associated with a 22% reduction in the average deficit in height-for-age among children under five (according to the WHO 2006 growth standard), 16% lower neonatal mortality (age <1 month) , 10% lower postneonatal mortality (age 1-11 months), 11% lower child mortality (age 12-59 months) , and 2% increase in school attendance among 7-16-year-olds. Adjusting further for maternal education, household living standards, maternal fertility and birth related factors, and neighborhood reduced the coefficients for maternal height by 22% for child height-for-age, 26% for neonatal mortality, 46% for postneonatal mortality, 56% for child mortality, and 90% for school attendance. The decomposition showed that adjusting for neighborhood had a substantial impact on the association of maternal height with all outcomes, especially child mortality. Adjusting for unobserved father and household factors also had a particularly large impact on the association with child mortality. The robustness of the relationship with neonatal mortality suggests that pregnancy and perinatal factors are an important link between maternal height and child outcomes. Adult living standards and socioeconomic and related behavioral factors likely play a small role. Genetics may also play a large role in linking maternal height and child height-for-age, especially for educated mothers, whose height was presumably impacted less by early life adversity.

The Effect of Parental Loss on Social Mobility in Early Twentieth-Century Sweden.

Parents are assumed to play a crucial role in the socioeconomic attainment of children. Through investments of both time and resources, they promote the ability, human capital, networks, and motivation of their children to advance socially, or at least to maintain their social position. Consequently, losing a parent in childhood could be detrimental to adult socioeconomic outcomes. We use full-count linked census data and a comprehensive death register to study the effect of parental loss on socioeconomic outcomes in adulthood in Sweden during the first half of the twentieth century. We employ sibling fixed-effects models and the Spanish flu as an exogenous mortality shock to assess the importance of endogeneity bias in associations between parental loss and socioeconomic outcomes. Maternal death led to worse socioeconomic outcomes in adulthood in terms of occupational and class attainment, as well as for social mobility. The effects seem to be causal but the magnitudes were small. For paternal death, we find no consistent pattern, and in most models there was no effect on sons' socioeconomic outcomes. The patterns were similar for sons and daughters and do not support the theory that parental loss had important negative effects on socioeconomic outcomes in adulthood.

The impact of kin proximity on net marital fertility and maternal survival in Sweden 1900-1910-Evidence for cooperative breeding in a societal context of nuclear families, or just contextual correlations?

OBJECTIVE: We investigate the association between the geographic proximity of the grandparents on net marital fertility and maternal survival in Sweden, 1900-1910, within the framework of the cooperative-breeding-hypothesis. METHODS: Data were derived from Swedish full-count censuses (1880-1910) and the Swedish Death Index. Married couples were linked to their parental households. Poisson and logistic regression analyses were used to investigate the association between the geographical proximity of the grandparents on net marital fertility, which we measured as the number of surviving children born between 1900 and 1910, and the mother's survival. Models were fitted with and without fixed effects to assess the effects of unobserved characteristics shared at the parish and the family level. RESULTS: The results indicate that net fertility and maternal survival increased with the husband's parents' geographic proximity. In contrast, we found no evidence that the geographic proximity of the wife's parents was associated with increased fertility or maternal survival. Rather, the presence of the mother's parents in the household lowered net fertility and reduced maternal survival. CONCLUSIONS: This study provides evidence that kin proximity was associated with fertility and mortality of married women, and that the associations differed for paternal and maternal kin in the societal context of Swedish nuclear families (1900-1910). However, the patterns of kin proximity that we identified were correlated with characteristics such as socioeconomic status, occupation, and wealth, which also exhibited strong correlations with fertility and survival. Future research assessing the effects of kinship on demographic developments must therefore carefully consider the socio-environmental context.

Social class and fertility: A long-run analysis of Southern Sweden, 1922-2015.

This paper examines social class differences in fertility, using longitudinal micro-level data for a regional sample in Sweden, 1922-2015. Using discrete-time event history models, we estimated the association between social class and parity-specific duration to next birth, adjusting for household income in separate models. Social class was associated with fertility quite independently from income and the association was both parity-dependent and sex-specific. For transitions to parenthood, higher class position was associated with higher fertility for men and lower fertility for women before 1970, but then converged into a positive association for both sexes after 1990. For continued childbearing, a weak U-shaped relationship before 1947 turned into a positive relationship for second births and a negative relationship for higher-order births in the period after 1990. These patterns likely reflect broader changes in work-family compatibility and are connected to profound shifts in labour markets and institutional arrangements in twentieth-century Sweden.

Changing speed of reduction in under-5 mortality rates over the 20th century.

BACKGROUND: Declines from high levels of under-5 mortality rate (U5MR) first occurred in Western Europe. Knowledge and technologies gained from early mortality reductions could accelerate the U5MR decline for countries that followed. We explored whether average annual reduction (AAR) in U5MR increased between countries over time in the 20th century. METHODS: We used U5MR time series from the Human Mortality Database and United Nations for 110 countries experiencing a decline from 100 to 50 under-5 deaths per 1000 live births during the 20th century. RESULTS: Between 1907 and 1938, the AAR was 2.61 (95% CI 2.09, 3.13) deaths per 1000 live births per year on average and increased by 0.06 (95% CI 0.02, 0.10) deaths for each year that passed before the decline started. Countries going through the decline in 1938-1968 and 1968-1999 showed an AAR of 3.96 and 3.67 (95% CI 3.37, 4.54 and 3.26, 4.07), respectively, with no increase in AAR. CONCLUSIONS: Acceleration in U5MR reduction was apparent in today's high-income countries, indicating that greater similarities and capacity may have facilitated the adaptation of mortality reducing knowledge and technologies. Greater emphasis on simple and individual-level interventions or more difficult circumstances may also explain the lack of acceleration in mortality reduction after 1950.

SES inequalities in cause-specific adult mortality: a study of the long-term trends using longitudinal individual data for Sweden (1813-2014).

Higher socioeconomic status (SES) is associated with lower mortality, and this correlation has been confirmed using different indicators across several geographical settings. Nevertheless, the timing of the emergence of the SES gradient remains unclear. We used individual-level longitudinal data for a regional population in southern Sweden covering the period between 1813 and 2014, and we applied a cause-specific proportional hazard model. We estimated SES differences in all-cause, nonpreventable, preventable, and cause-specific adult mortality in four subperiods (1813-1921, 1922-1967, 1968-1989, 1990-2014) by gender adjusting for birth year, place of residence, marital status, and migration status. The SES gradient in mortality present today for both genders emerged only around 1970, and with few exceptions, it emerged at approximately the same time for all causes of death. It emerged earlier for women than for men, particularly in infectious diseases. In the nineteenth and early twentieth centuries, we found a positive association between SES and mortality from circulatory diseases for men. SES has not always been a fundamental cause of mortality; it only emerged as such in the second half of the twentieth century. We argue that habits and behaviors embedded in the different social strata played a major role in the emergence of the SES gradient.

The social context of nearest neighbors shapes educational attainment regardless of class origin.

We study the association between sociospatial neighborhood conditions throughout childhood and educational attainment in adulthood. Using unique longitudinal microdata for a medium-sized Swedish town, we geocode its population at the address level, 1939 to 1967, and link individuals to national registers, 1968 to 2015. Thus, we adopt a long-term perspective on the importance of nearby neighbors during a period when higher education expanded. Applying a method for estimating individual neighborhoods at the address level, we analyze the association between the geographically weighted social class of the nearest 6 to 100 childhood neighbors (ages 2 to 17), and the likelihood of obtaining a university degree by age 40, controlling for both family social class and school districts. We show that even when growing up in a town with relatively low economic inequality, the social class of the nearest same-age neighbors in childhood was associated with educational attainment, and that the associations were similar regardless of class origin. Growing up in low-class neighborhoods lowered educational attainment; growing up in high-class neighborhoods increased attainment. Social class and neighborhoods reinforced each other, implying that high-class children clustered with each other had much higher odds of obtaining a university degree than low-class children from low-class neighborhoods. Thus, even if all groups benefited from the great expansion of free higher education in Sweden (1960s to 1970s), the large inequalities between the classes and neighborhoods remained unchanged throughout the period. These findings show the importance of an advantageous background, both regarding the immediate family and the networks of nearby people of the same age.

When Did the Health Gradient Emerge? Social Class and Adult Mortality in Southern Sweden, 1813-2015.

Across today's developed world, there is a clear mortality gradient by socioeconomic status for all ages. It is often taken for granted that this gradient was as strong-or even stronger-in the past when social transfers were rudimentary and health care systems were less developed. Some studies based on cross-sectional data have supported this view, but others based on longitudinal data found that this was not the case. If there was no gradient in the past, when did it emerge? To answer this question, we examine social class differences in adult mortality for men and women in southern Sweden over a 200-year period, using unique individual-level register data. We find a systematic class gradient in adult mortality emerging at ages 30-59 only after 1950 for women and after 1970 for men, and in subsequent periods also observable for ages 60-89. Given that the mortality gradient emerged when Sweden transitioned into a modern welfare state with substantial social transfers and a universal health care system, this finding points to lifestyle and psychosocial factors as likely determinants.

Immigration and Child Mortality: Lessons from the United States at the turn of the Twentieth Century.

The societal integration of immigrants is a great concern in many of today's Western societies, and has been so for a long time. Whether we look at Europe in 2015 or the United States at the turn of the twentieth century, large flows of immigrants pose challenges to receiving societies. While much research has focused on the socioeconomic integration of immigrants there has been less interest in their demographic integration, even though this can tell us as much about the way immigrants fare in their new home country. In this paper we study the disparities in infant and child mortality across nativity groups and generations, using new, high-density census data. In addition to describing differentials and trends in child mortality among 14 immigrant groups relative to the native-born white population of native parentage, we focus special attention on the association between child mortality, immigrant assimilation, and the community-level context of where immigrants lived. Our findings indicate substantial nativity differences in child mortality, but also that factors related to the societal integration of immigrants explains a substantial part of these differentials. Our results also point to the importance of spatial patterns and contextual variables in understanding nativity differentials in child mortality.

Spatial and Social Distance at the Onset of the Fertility Transition: Sweden, 1880-1900.

Most studies on the fertility transition have focused either on macro-level trends or on micro-level patterns with limited geographic scope. Much less attention has been given to the interplay between individual characteristics and contextual conditions, including geographic location. Here we investigate the relevance of geography and socioeconomic status for understanding fertility variation in the initial phase of the Swedish fertility transition. We conduct spatially sensitive multilevel analyses on full-count individual-level census data. Our results show that the elite constituted the vanguard group in the fertility decline and that the shift in fertility behavior occurred quickly among them in virtually all parts of Sweden. Other socioeconomic status groups experienced the decline with some delay, and their decline patterns were more clustered around early centers of the decline. Long-distance migrants initially had higher fertility than people living close to their birthplace. However, as the fertility decline unfolded, this advantage was either reduced or reversed. This supports the view that migration and fertility are linked in this process. Our results confirm that socioeconomic status differences were of considerable relevance in structuring the fertility transition. The degree to which spatial distance fostered spatial variation in the fertility decline seems to have been negatively correlated with socioeconomic status, with the pattern of decline among the elite showing the lowest degree of spatial variation.

Social Class and Excess Mortality in Sweden During the 1918 Influenza Pandemic.

Consensus is lacking in the literature about the role of socioeconomic factors on influenza-associated deaths during the 1918 pandemic. Although some scholars have found that social factors were important, others have not. In this study, we analyzed differences in excess mortality by social class in Sweden during the 1918 pandemic. We analyzed individual-level mortality of the entire population aged 30-59 years by combining information from death records with census data on occupation. Social class was measured by an occupation-based class scheme. Excess mortality during the pandemic was measured as the number of deaths relative to the number occurring in the same month the year before. Social class differences in numbers of deaths were modeled using a complementary log-log model that was adjusted for potential confounding at the family, the residential (urban/rural), and the county levels. We found notable class differences in excess mortality but no perfect class gradient. Class differences were somewhat larger for men than for women.

Socio-economic status and fertility decline: Insights from historical transitions in Europe and North America.

The timings of historical fertility transitions in different regions are well understood by demographers, but much less is known regarding their specific features and causes. In the study reported in this paper, we used longitudinal micro-level data for five local populations in Europe and North America to analyse the relationship between socio-economic status and fertility during the fertility transition. Using comparable analytical models and class schemes for each population, we examined the changing socio-economic differences in marital fertility and related these to common theories on fertility behaviour. Our results do not provide support for the hypothesis of universally high fertility among the upper classes in pre-transitional society, but do support the idea that the upper classes acted as forerunners by reducing their fertility before other groups. Farmers and unskilled workers were the latest to start limiting their fertility. Apart from these similarities, patterns of class differences in fertility varied significantly between populations.

The impact of socio-economic status on net fertility during the historical fertility decline: a comparative analysis of Canada, Iceland, Sweden, Norway, and the USA.

We used micro-level data from the censuses of 1900 to investigate the impact of socio-economic status on net fertility during the fertility transition in five Northern American and European countries (Canada, Iceland, Norway, Sweden, and the USA). The study is therefore unlike most previous research on the historical fertility transition, which used aggregate data to examine economic correlates of demographic behaviour at regional or national levels. Our data included information on number of children by age, occupation of the mother and father, place of residence, and household context. The results show highly similar patterns across countries, with the elite and upper middle classes having considerably lower net fertility early in the transition. These patterns remain after controlling for a range of individual and community-level fertility determinants and geographical unobserved heterogeneity.

Educational homogamy and gender-specific earnings: Sweden, 1990-2009.

Several studies have shown strong educational homogamy in most Western societies, although the trends over time differ across countries. In this article, we study the connection between educational assortative mating and gender-specific earnings in a sample containing the entire Swedish population born 1960-1974; we follow this sample from 1990 to 2009. Our empirical strategy exploits a longitudinal design, using distributed fixed-effects models capturing the impact of partner education on postmarital earnings, relating it to the income development before union formation. We find that being partnered with someone with more education (hypergamy) is associated with higher earnings, while partnering someone with less education (hypogamy) is associated with lower earnings. However, most of these differences in earnings emerge prior to the time of marriage, implying that the effect is explained by marital selection processes rather than by partner education affecting earnings. The exception is hypogamy among the highly educated, for which there are strong indications that in comparison with homogamy and hypergamy, earnings grow slower after union formation.

Cultural dissimilarity and intermarriage. a longitudinal study of immigrants in Sweden, 1990­2005.

Intermarriage with natives is a key indicator of immigrant integration. This article studies intermarriage for 138 immigrant groups in Sweden, using longitudinal individual level data. It shows great variation in marriage patterns across immigrant populations, ranging from over 70 percent endogamy in some immigrants groups to below 5 percent in other groups. Although part of this variation is explained by human capital and the structure of the marriage market, cultural factors (values, religion, and language) play an important role as well. Immigrants from culturally more dissimilar countries are less likely to intermarry with natives, and instead more prone to endogamy.

Status homogamy in the preindustrial marriage market: partner selection according to age, social origin, and place of birth in nineteenth-century rural Sweden.

This article studies partner selection according to three dimensions: social origin, age, and place of birth. The authors use micro-level data from local population registers in five parishes in southern Sweden from 1815 to 1895. The results confirm that all three aspects were important but that socioeconomic status was the most important characteristic, structuring much of the selection process. The importance of social and age homogamy remained stable over the period, while geographic exogamy became more frequent, which could be interpreted in terms of an increasing openness of rural society. The authors also find some indications of exchange of characteristics in the partner selection process.

Widowhood, family size, and post-reproductive mortality: a comparative analysis of three populations in nineteenth-century Europe.

Researchers from a number of disciplines have offered competing theories about the effects oJ childbearing on parents 'postreproductive longevity. The "disposable soma theory" argues that investments in somatic maintenance increase longevity but reduce childbearing. "Maternal depletion" models suggest that the rigors of childrearing increase mortality in later years. Other researchers consider continued childbearing a sign of healthy aging and a predictor of future longevity. Empirical studies have produced inconsistent and contradictory results. Our focus is on the experience of widowhood, which has been ignored in previous studies. We hypothesize that the death of a spouse is a stressful event with long-term consequences for health, especially for women with small children. Data are drawn from historical sources in Sweden, Belgium, and the Netherlands from 1766 to 1980. Postreproductive mortality was highest among young widows with larger families in all three samples. Age at last birth had little or no effect. We conclude that raising children under adverse circumstances can have long-lasting, harmful effects on a mother's health.

Deliberate control in a natural fertility population: southern Sweden, 1766-1864.

In this article, we analyze fertility control in a rural population characterized by natural fertility, using survival analysis on a longitudinal data set at the individual level combined with food prices. Landless and semilandless families responded strongly to short-term economic stress stemming from changes in prices. The fertility response, both to moderate and large changes in food prices, was the strongest within six months after prices changed in the fall, which means that the response was deliberate. People foresaw bad times and planned their fertility accordingly. The result highlights the importance of deliberate control of the timing of childbirth before the fertility transition, not in order to achieve a certain family size but, as in this case, to reduce the negative impacts of short-term economic stress.