Are health inequalities decreasing in Sweden?

Abstract Background The overarching national goal for the Swedish public health policy is to create societal conditions for good and equitable health for all and to eliminate avoidable inequalities within a generation (until 2048). To know whether we are heading towards the public health policy goal, a surveillance system which follows a combination of several inequality measures over time, is needed. Methods All-cause mortality in age 25-64 and life expectancy at age 30, in the total population of Sweden, were used as measures of health and followed 2006-2022. Education (low, middle, high) was used to measure socioeconomic position. Both absolute and relative, and both simple and complex measures were used to analyse inequalities in mortality: rate difference (RD), relative risk (RR), population attributable fraction (PAF) and population attributable number (PIN). Life expectancy was analysed as absolute and relative difference in remaining number of years. Results Life expectancy has increased and mortality in age 25-64 have decreased in the Swedish general population. Comparing those with low and high education, both absolute and relative inequalities have increased, e.g. differences in life expectancy increased to > 6 years among men and almost 7 years among women, and relative inequality in mortality in age 25-64 increased to > 3 times higher risk (RR 3.1; CI 3.0-3.3). Inequality, measured with regard to all groups in the population, showed no noticeable changes over time. Conclusions The results show that Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25-64. To use a combination of health inequality measures strengthens the surveillance system and gives a more nuanced picture of the development. It enables, in parallel with universal health improving efforts, focus on the groups with the poorest health, where efforts have the greatest effect. Key messages • Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25–64. • A more nuanced picture of inequalities is crucial to be able to parallel universal health-improving efforts with a focus on the groups with the poorest health, where efforts have the greatest effect.