Old age, health and social inequality

Background: Social position is one of the major determinants of health. Less is known about its effect in historical contexts. Previous studies have shown surprisingly small effects of social class in working age populations. Not much is known about social differences in health among the elderly in history. Objective: The present paper analyses social differences in health among the elderly (60+) in the Sundsvall region in northern Sweden during the 19th century. We investigate whether social mortality differences are particularly apparent in old age when unpropertied groups lost their most important asset for survival: their capacity to work. Methods: The data, representing 9,535 fatal events, are analysed using a Cox regression model, assuming proportional hazards. Results: Social class had no significant effect for women during the pre-industrial period, while only those with unknown social position had higher mortality among men. During the industrial period female mortality was lowest in the skilled working class and highest in the upper class. Social position was not significant for men in the full model. Urban mortality was 30% higher for women and 59% higher for men during the pre-industrial period compared to the peripheral parishes. Conclusions: The results lead us to question the accepted 'fact' of social health differences as a historical constant. Higher social position did not lead to better survival, and social differences in mortality did not increase in old age, despite the fact that the elderly were a highly vulnerable group. Instead, the spatial aspects of mortality were important, particularly during the pre-industrial period.