The mortality gradient in town and country: Social class and childhood mortality in Sweden at the turn of the twentieth century

Abstract

This study examines social‐class and urban–rural differentials in childhood mortality in Sweden from 1880 to 1910, a period of steady mortality decline, ongoing industrialization, and urbanization. Urbanization brought improvements in water quality and sanitation but also increased risks from overcrowding, pollution, and infectious diseases. It remains unexplored whether these changes narrowed or widened the class gap in infant and child mortality. We use full‐count Swedish censuses linked to the Swedish Death Index (SDI), which provides near‐comprehensive coverage of all deaths and allows for reliable estimation of mortality in ages 1–9 years. Detailed census data enable analysis of parental household characteristics. Due to undercounting of infant deaths, we use under‐five sex ratios as a proxy for infant mortality. Results show a strong urban penalty in both infant and child mortality in the late nineteenth century, which diminished in the early twentieth century. Pronounced class differences existed in child mortality in both urban and rural areas but not in infant mortality. Although absolute class differences narrowed over time, relative inequalities persisted in urban areas but largely disappeared in rural settings. These findings reveal substantial inequalities in child survival during industrialization linked to both urban residence and social class.