A longitudinal study of how disability affects mortality in Swedish Populations from the 1800s, 1900s and 2000s

BACKGROUND: Studies from across the world show that disability limits people’s health and social wellbeing in present-day populations. This disadvantage can lead to premature death, but there is dearth knowledge about the relationship between disability and mortality and changes over time. OBJECTIVES: Unique access to longitudinal micro data on comprehensive Swedish populations enabled us to examine how disability affects premature death in men and women from the 1800s until 2010. METHODS: Cox proportional regressions were used to estimate mortality hazards by disability status, gender and socio-economic indicators in three study populations from the 1800s, 1900s and 2000s. We followed all adults having disability from age 25 to compare their premature death risks (< age 43) relative to non-disabled groups. RESULTS: Irrespective of gender and century studied, the adjusted hazard ratios show that adults with disabilities had a significantly higher premature death risk relative to adults without disabilities, and it increased over time. In the 1800s, disability about doubled this risk (HR: 2.31, CI: 1.65–3.22) and it tripled from 1900–1959 (HR 3.01, CI 2.60– 3.48). At the turn of the 21th century, the mortality risk was almost ten-folded (HR 9.90, CI 8.03–10.5). CONCLUSIONS: This study provides the first comprehensive estimates on how disability increased mortality in Swedish populations from the 1800s until the 2000s. Across three centuries, disability was associated with a profoundly higher relative death risk in adults aged 25–42. This risk grew when the general survival in Sweden improved and it was the highest in the 1990–2010 period. Fundamental societal changes and extensive welfare provisions promoting equality in gender, health and social wellbeing of all citizens have not come to include younger generations with disabilities.