International Journal of Public Health

, Volume 60, Issue 3, pp 363–373 | Cite as

Longitudinal trends in good self-rated health: effects of age and birth cohort in a 25-year follow-up study in Sweden

  • Sven-Erik Johansson
  • Patrik Midlöv
  • Jan Sundquist
  • Kristina Sundquist
  • Susanna CallingEmail author
Original Article



Although average life expectancy has increased considerably in Sweden, there is less evidence for improved self-rated health (SRH). We analyzed longitudinal trends in SRH between 1980/1981 and 2004/2005 in age and birth cohort subgroups.


2,728 males and 2,770 females, aged 16–71 years, were interviewed every eighth year. Mixed models with random intercepts were used to estimate changes in SRH within different age groups and birth cohorts, adjusting for potential confounders.


During the 25-year follow-up, SRH improved in individuals aged ≥48 years, but became poorer or was unchanged in those aged 16–47 years. All birth cohorts showed poorer SRH with increasing age, with an adjusted odds ratio (95% confidence interval) of 0.94 (0.93–0.95) in males and 0.92 (0.91–0.93) in females.


While SRH in the older age groups improved, SRH became poorer in the youngest. Poorer SRH is deeply worrying for the affected individuals, and may also have a negative impact on the health care system. Although mental illness, socioeconomic factors, and lifestyle may be potential mechanisms, future studies are needed to investigate the reasons behind this trend.


Self-rated health Longitudinal studies Age effect Cohort effect Mixed models 


Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

This study was approved by the ethics committee in Stockholm (approval No. 12/2000).


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Copyright information

© Swiss School of Public Health 2015

Authors and Affiliations

  • Sven-Erik Johansson
    • 1
  • Patrik Midlöv
    • 1
  • Jan Sundquist
    • 1
    • 2
  • Kristina Sundquist
    • 1
    • 2
  • Susanna Calling
    • 1
    Email author
  1. 1.Department of Clinical Sciences in Malmö, Center for Primary Health Care ResearchLund UniversityMalmöSweden
  2. 2.Stanford Prevention Research CenterStanford UniversityPalo AltoUSA

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