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Abstract Background Increasing health inequalities among older adults globally illustrate the urgent need for effective interventions. Socio-economic position (SEP) may affect healthy ageing through various life course mechanisms. However, longitudinal associations between life course SEP and healthy ageing as a multidimensional construct remain unclear. Methods We conducted a comprehensive systematic review of longitudinal studies investigating the associations between life course SEP indicators and multidimensional healthy ageing outcomes. A systematic literature search was conducted across four databases (MEDLINE, Embase, PsycINFO, and Web of Science) from inception to April 2025. Due to the heterogeneity in the operationalisation of SEP and healthy ageing, a narrative synthesis was performed (Prospero CRD42023418728). Results 47 articles were included in the review. Across multiple SEP indicators and life stages, higher educational levels (39/43 studies) and higher income/wealth (31/36 studies) were positively associated with better healthy ageing. Occupation showed inconsistent evidence. Life-course evidence showed childhood SEP disadvantage predicted poorer later-life outcomes (13/17 studies), with cumulative multi-stage disadvantage showing additive effects (5 studies) and upward mobility conferring benefits (3 studies). These patterns manifested in three age-related inequality trajectories: widening (18/23 studies), convergence, and persistence, with education-cognitive disparities showing strongest widening effects. Cross-national evidence revealed regional specificities. Studies also identified gender moderation effects (5 studies) and examined mediating pathways (6 studies). Conclusion Education showed the most consistent protective effects, while income/wealth effects were complex. Health inequalities widened with age, highlighting lasting childhood impacts. Targeted interventions addressing early educational investment and life stage-specific strategies are needed for reducing healthy ageing inequalities.