Trends in educational inequalities in all-course mortality and deaths of despair in Swedish youths 1990-2018.

Bakground: Growing educational disparities in mortality due to suicide, drug overdose, or alcohol-related liver disease - or "deaths of despair" (DoD) - have received increased attention in research and public debate. However, no study has investigated educational differences in despair-related mortality outside of North America. Thus, the aim this study was to investigate changes in the association between academic achievement in compulsory school and subsequent all-cause mortality (ACM) and DoD between 1990 and 2018 in Swedish youths. Data and methods: Register data on all students graduating from compulsory school in Sweden between 1990 and 2010 were used (N = 2 252 938). Students were followed for a maximum of 8 years using discrete time proportional hazard models. Academic achievement was measured by grades at the end of compulsory school. Results: ACM declined for medium/high achieving but not for low-achieving youths, while DoD increased slightly for medium/high achieving and markedly for low-achieving youths, resulting in growing achievement-related disparities in both types of mortality. The trends were primarily driven by native-born youth and girls. Conclusions: The trends in Swedish youths resemble the trends in the American working-age population, but partly contrasts with corresponding trends in other European countries. Future research should investigate if the underlying causes that have been emphasized in the American context - socio-economic transformations and a greater supply of drugs - have also contributed to the Swedish trends.