Coevolution of education and income inequalities in mortality

Abstract Background Education and income are independent predictors of mortality, but they also interact so that educational inequalities in mortality are larger at low levels of income. However, the average educational attainment in high-income countries has risen during recent decades and it is unclear how the interplay between education and income on mortality has changed over time. We studied this in the Nordic welfare state context of Finland and Sweden. Data & methods We used individual level register-linked data from Finland and Sweden of all individuals aged 30-64 in three-year periods from 1994-1996 to 2018-2020. We estimated three-way interactions in Poisson regression models between attained educational level, household income quintile and study period separately for both countries and genders. Results The educational inequalities in mortality are substantially larger in lower levels of income and these inequalities are slightly higher in Finland compared to Sweden. Absolute educational inequalities in the lowest income quintile remained unchanged among men but increased substantially among women. The rate difference changed from 21 to 36 in Finland and from 19 to 30 in Sweden, mostly due to rising mortality among women with basic education and low income in both countries. Conclusions Due to educational expansion the proportion of those bearing the double burden of basic education and low income is declining but they are experiencing increasing or stagnating mortality development likely driven by changes in labour market dynamics and composition of lowest educational group. Policy measures aimed at tackling health inequalities should consider groups with multiple disadvantages. Key messages • Educational inequalities in mortality are wider at lower levels of income and this association has grown stronger over time among women in Finland and Sweden. • Due to educational expansion the proportion of those with basic education and low income is declining but their mortality development is increasingly adverse particularly among women.