Educational inequalities in mortality by generation among foreign background individuals in Sweden

Background

International migrants often experience health advantages and lower income inequalities in mortality relative to native-majority populations, which tend to diminish with longer duration of residence. Recent evidence has also suggested that income inequalities in mortality increase by migrant generation, yet it remains unclear whether similar patterns are evident by education. This study aims to investigate the extent to which educational inequalities in mortality are evident among first-generation migrants and second-generation individuals in Sweden.

Methods

Longitudinal data from Swedish population registers (2004-2018) was used to identify residents aged 30-64. Poisson regression models were used to assess associations between educational inequalities, computed with the Relative Index of Inequality, and all-cause mortality among native-majority Swedes and eight groups of foreign-background individuals, categorized by own or parental origin and generation. Sub-analyses examined the contribution of external causes to educational inequalities in mortality.

Results

Relative to the native-majority population, educational inequalities in mortality were lower among first-generation migrants. Among men, inequalities appeared to increase by generation, but were of a greater magnitude among those with non-European backgrounds compared to those with European backgrounds. However, the most pronounced inequalities were observed among men and women born in Sweden with one parent of native-majority ancestry and one parent of non-European origin, with external causes of death accounting for 20-49% of the observed inequalities in mortality.

Conclusions

Educational inequalities in mortality vary considerably among individuals with foreign backgrounds. Inequalities and are more pronounced among certain second-generation groups, with external causes explaining much of the observed variation between groups, indicating a need for targeted interventions.

Key messages

• Second generation men show higher educational inequalities in mortality than the native-born majority and first-generation migrants.

• The most pronounced educational inequalities are observed in second-generation men and women with both majority Swedish and Non-European parents.