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Intersectional inequalities in self-rated health in Germany across sex/gender, migration, education and income: a cross-sectional study

Background Health inequalities by sex/gender, migration, education and income persist across Europe, yet intersectionality-informed research on how these social positions jointly shape self-rated health (SRH) remains limited. - Methods We conducted a cross-sectional analysis of the German National C...

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Autori principali: Slesinski, S. Claire (Autore) , Bilal, Usama (Autore) , Heisig, Jan Paul (Autore) , Telkmann, Klaus (Autore) , Callies, Carolin Marie (Autore) , Emmer, Christine (Autore) , Becher, Heiko (Autore) , Brand, Tilman (Autore) , Glaser, Nadine (Autore) , Harth, Volker (Autore) , Herrmann, Anne (Autore) , Keil, Thomas (Autore) , Leitzmann, Michael (Autore) , Meinke-Franze, Claudia (Autore) , Mikolajczyk, Rafael (Autore) , Obi, Nadia (Autore) , Schmidt, Börge (Autore) , Schwichtenberg, Julia (Autore) , Willich, Stefan N. (Autore) , Zeeb, Hajo (Autore) , Peters, Annette (Autore) , Schneider, Alexandra (Autore) , Bozorgmehr, Kayvan (Autore) , Rehfuess, Eva (Autore) , Razum, Oliver (Autore) , Bolte, Gabriele (Autore)
Natura: Article (Journal)
Lingua:inglese
Pubblicazione: 2026
In: Journal of epidemiology and community health
Year: 2026, Pages: 1-9
ISSN:1470-2738
DOI:10.1136/jech-2026-225920
Accesso online:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/jech-2026-225920
Verlag, lizenzpflichtig, Volltext: https://jech.bmj.com/content/early/2026/06/22/jech-2026-225920
Testo
Note sull'autore:S. Claire Slesinski, Usama Bilal, Jan P. Heisig, Klaus Telkmann, Carolin Marie Callies, Christine Emmer, Heiko Becher, Tilman Brand, Nadine Glaser, Volker Harth, Anne Herrmann, Thomas Keil, Michael Leitzmann, Claudia Meinke-Franze, Rafael Mikolajczyk, Nadia Obi, Börge Schmidt, Julia Schwichtenberg, Stefan N. Willich, Hajo Zeeb, Annette Peters, Alexandra Schneider, Kayvan Bozorgmehr, Eva Rehfuess, Oliver Razum, Gabriele Bolte
Descrizione
Riassunto:Background Health inequalities by sex/gender, migration, education and income persist across Europe, yet intersectionality-informed research on how these social positions jointly shape self-rated health (SRH) remains limited. - Methods We conducted a cross-sectional analysis of the German National Cohort (NAKO; n=179 861). Sex/gender, education and income were combined with three migration characteristics (any migration, Turkish and ethnic German resettler backgrounds) into three 16-strata exposure variables. We used Poisson regression with robust SEs to estimate adjusted frequencies and relative risks of poor SRH, adjusting for age, household size and study site. Departures from additivity were assessed using two-, three-, four-way and total relative excess risk due to interaction (RERI). - Results Poor SRH followed a social gradient. Adjusted frequency of poor SRH generally increased with each additional marginalised social position, from 6.3% (95% CI 5.5% to 7.2%) among high education and income migrant men to 22.6% (95% CI 21.3% to 23.8%) among low education and income migrant women. Adjusted frequencies were highest among participants with Turkish background. Joint exposure to female sex/gender, migration and low education and income was associated with risk of poor SRH beyond the sum of individual effects. Total RERIs for four-way intersections were 1.10 (95% CI 0.83 to 1.37) for any migration, 3.09 (95% CI 2.02 to 4.15) for Turkish and 1.62 (95% CI 0.84 to 2.41) for ethnic German resettler backgrounds. - Conclusions SRH in Germany exhibits pronounced intersectional inequalities. Individuals occupying multiple marginalised social positions experienced a disproportionate burden of poor SRH, highlighting the importance of intersectionality in population health monitoring.
Descrizione del documento:Gesehen am 30.07.2026
Descrizione fisica:Online Resource
ISSN:1470-2738
DOI:10.1136/jech-2026-225920

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