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Objective. Lack of adherence with pharmacological therapy is a public health concern that compels tremendous costs for the health care system and the community. To analyse the association between socioeconomic disadvantage and primary nonadherence with medication, and to explore possible mediating effects of trust in health care and lifestyle profile. Design. Cross-sectional population-based study based on data from the Swedish national public health surveys 2004-2005. Participants. The study comprised 13603 men and 18292 women aged 21-84 years who had any contact with a physician at a hospital or primary care centre. Measures. Primary non-adherence with medication based on whether respondents reported that they refrained from purchasing at the pharmacy prescribed medication. Socioeconomic Disadvantage Index was based on four different indicators of economic deprivation. Results. Socioeconomic disadvantage was associated with primary non-adherence with medication independent of long-term illness, risky lifestyle, low education, living alone and low trust for health care. This association increased with older age, particularly among women. Among individuals aged 21-34 years, severe compared with no socioeconomic disadvantage, was associated with two-fold increased odds for non-adherence with medication. The: corresponding odds among individuals aged 65-84 years were three-fold increase among elderly men (OR = 3.3, 95% CI: 1.4-7.8) and six-fold increase among elderly women (OR = 6.2, 95% CI: 2.5-15.3). Yet every seventh elderly woman aged 65-84 years suffered from long-term illness. Conclusions. Results indicate that health policies for 'care on equal terms' in Sweden have been less successful in relation to equitable access to prescribed medication, especially among the elderly.