Trends in educational inequalities in all-course mortality and deaths of despair in Swedish youths 1990-2018.
Level 3 - non-randomized controlled study
Nationwide population-based registry cohort study
PubMed 39886260 · doi:10.1016/j.ssmph.2025.101748
What was done
Researchers analyzed Swedish national register data covering all students graduating from compulsory school between 1990 and 2010 (N = 2,252,938). Students were followed for a maximum of 8 years (spanning 1990 to 2018) using discrete time proportional hazard models to evaluate changes in the association between compulsory school academic achievement (school grades) and subsequent all-cause mortality (ACM) and deaths of despair (DoD: suicide, drug overdose, or alcohol-related liver disease).
What was found
The abstract reports directional trends without providing specific numerical risk estimates, death counts, or confidence intervals. All-cause mortality declined over time among medium- and high-achieving youths but remained unchanged among low-achieving youths. Deaths of despair increased slightly among medium- and high-achieving youths and increased markedly among low-achieving youths, widening achievement-related disparities for both outcomes. These diverging trends were primarily driven by native-born youth and girls.
Why it matters
This study provides evidence that growing educational disparities in despair-related mortality are not confined to the North American context and can develop among youth within a universal welfare state.
Limits
The abstract contains no numerical effect estimates, event counts, or confidence intervals. Follow-up was limited to a maximum of 8 years post-graduation, restricting outcomes to youth and early adulthood. The observational registry design cannot establish specific causal mechanisms behind the observed trends.