Does intergenerational social mobility among men affect cardiovascular mortality? A population-based register study from Sweden.

Background: Socioeconomic inequalities in cardiovascular mortality are well documented. The aim here is to examine the relation between childhood and adulthood class as well as the role of unique intergenerational social mobility trajectories in such mortality.

Methods: Data were obtained from Swedish registries. Childhood and adulthood information were from the 1960 and 1990 censuses. Men born 1945-59 (809,199) were followed-up for four cardiovascular mortality outcomes 1990-2002 (5533 deaths) by means of Cox regressions. Three different approaches were applied to study mobility between four main classes.

Results: In mutually adjusted models, the effect of a manual adulthood class (compared with non-manuals) was clearly larger (hazard ratios (HR) were 1.56 for MI, 1.70 for stroke, 1.64 for other cardiovascular disease (CVD), 1.62 for all CVD) as for a manual childhood class (1.38, 1.17, 1.24 and 1.28, respectively). This also applied to unclassifiable, while there were few systematic findings for self-employed. When adjusting for education level, childhood class was still significant for MI, other and all CVD, but adulthood class was significant for all outcomes. Trajectory-specific analyses revealed that mobile men from non-manual to manual had significantly higher mortality than mobile from manual to non-manual and stable non-manuals, but not significantly lower than stable manuals.

Conclusions: Cardiovascular mortality was clearly structured by adulthood class, but not as consistently structured by childhood class. The mediating role of education suggests that a major part of life-course disadvantages or advantages in relation to CVD was due to achieved education.