Trends in health inequalities in childhood and adolescence in Germany: Results of the HBSC study 2009/10 – 2022

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Abstract

Background

Many studies have identified health inequalities in childhood and adolescence. However, it is unclear how these have developed in recent years, particularly since the COVID-19 pandemic.

Methods

Analyses are based on the German data from the international Health Behaviour in School-aged Children (HBSC) study from 2009/10 (n = 5,005), 2013/14 (n = 5,961), 2017/18 (n = 4,347), and 2022 (n = 6,475). A total of 21,788 students aged approximately between 11 and 15 years were included. Socioeconomic status (SES) was assessed using the Family Affluence Scale (FAS). Several health indicators were analysed stratified by gender using bivariate and multivariate analysis methods.

Results

In 2022, there are clear socioeconomic inequalities in life satisfaction, self-rated health, fruit and vegetable consumption, and physical activity. These inequalities remained largely constant or increased between 2009/10 and 2022. Between 2017/18 and 2022, no significant changes in inequalities were found.

Conclusions

Health inequalities are persistent and reduce the chances of growing up healthy. There is no evidence that inequalities in the analysed outcomes have changed during the pandemic period (between 2017/18 and 2022). Rather, the changes in the health indicators seem to affect all adolescents in a similar way.

Related collections

Most cited references 55

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Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies

Ellen L Idler, Yael Benyamini (1997)

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Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review.

Robert Reiss (2013)

Socioeconomic inequalities in health are an important topic in social sciences and public health research. However, little is known about socioeconomic disparities and mental health problems in childhood and adolescence. This study systematically reviews publications on the relationships between various commonly used indicators of socioeconomic status (SES) and mental health outcomes for children and adolescents aged four to 18 years. Studies published in English or German between 1990 and 2011 were included if they reported at least one marker of socioeconomic status (an index or indicators, e.g., household income, poverty, parental education, parental occupation status, or family affluence) and identified mental health problems using validated instruments. In total, 55 published studies met the inclusion criteria, and 52 studies indicated an inverse relationship between socioeconomic status and mental health problems in children and adolescents. Socioeconomically disadvantaged children and adolescents were two to three times more likely to develop mental health problems. Low socioeconomic status that persisted over time was strongly related to higher rates of mental health problems. A decrease in socioeconomic status was associated with increasing mental health problems. The strength of the correlation varied with age and with different indicators of socioeconomic status, whereas heterogeneous findings were reported for gender and types of mental health problems. The included studies indicated that the theoretical approaches of social causation and classical selection are not mutually exclusive across generations and specific mental health problems; these processes create a cycle of deprivation and mental health problems. The review draws attention to the diversity of measures used to evaluate socioeconomic status, which might have influenced the comparability of international epidemiological studies. Furthermore, the review highlights the need for individual-level early childhood interventions as well as a reduction in socioeconomic inequalities at a societal level to improve mental health in childhood and adolescence. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Adolescents' perceptions of social status: development and evaluation of a new indicator.

E. Goodman, N Adler, I Kawachi … (2001)

Eliminating health disparities, including those that are a result of socioeconomic status (SES), is one of the overarching goals of Healthy People 2010. This article reports on the development of a new, adolescent-specific measure of subjective social status (SSS) and on initial exploratory analyses of the relationship of SSS to adolescents' physical and psychological health. A cross-sectional study of 10 843 adolescents and a subsample of 166 paired adolescent/mother dyads who participated in the Growing Up Today Study was conducted. The newly developed MacArthur Scale of Subjective Social Status (10-point scale) was used to measure SSS. Paternal education was the measure of SES. Indicators of psychological and physical health included depressive symptoms and obesity, respectively. Linear regression analyses determined the association of SSS to depressive symptoms, and logistic regression determined the association of SSS to overweight and obesity, controlling for sociodemographic factors and SES. Mean society ladder ranking, a subjective measure of SES, was 7.2 +/- 1.3. Mean community ladder ranking, a measure of perceived placement in the school community, was 7.6 +/- 1.7. Reliability of the instrument was excellent: the intraclass correlation coefficient was 0.73 for the society ladder and 0.79 for the community ladder. Adolescents had higher society ladder rankings than their mothers (micro(teen) = 7.2 +/- 1.3 vs micro(mom) = 6.8 +/- 1.2; P =.002). Older adolescents' perceptions of familial placement in society were more closely correlated with maternal subjective perceptions of placement than those of younger adolescents (Spearman's rho(teens <15 years) = 0.31 vs Spearman's rho(teens 15 years) = 0.45; P <.001 for both). SSS explained 9.9% of the variance in depressive symptoms and was independently associated with obesity (odds ratio(society) = 0.89, 95% confidence interval = 0.83, 0.95; odds ratio(community) = 0.91, 95% confidence interval = 0.87, 0.97). For both depressive symptoms and obesity, community ladder rankings were more strongly associated with health than were society ladder rankings in models that controlled for both domains of SSS. This new instrument can reliably measure SSS among adolescents. Social stratification as reflected by SSS is associated with adolescents' health. The findings suggest that as adolescents mature, SSS may undergo a developmental shift. Determining how these changes in SSS relate to health and how SSS functions prospectively with regard to health outcomes requires additional research.

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Author and article information

Journal

Journal ID (nlm-ta): J Health Monit

Journal ID (iso-abbrev): J Health Monit

Journal ID (publisher-id): JoHM

Title: Journal of Health Monitoring

Publisher: Robert Koch Institute (Nordufer 20 13353 Berlin, Germany )

ISSN (Electronic): 2511-2708

Publication date (Electronic): 04 March 2024

Publication date Collection: March 2024

Volume: 9

Issue: 1

Pages: 79-98

Affiliations

[1 ] Martin Luther University Halle-Wittenberg , Halle (Saale), Medical Faculty, Interdisciplinary Centre for Health Sciences (PZG), Institute of Medical Sociology

[2 ] University Medical Centre Hamburg-Eppendorf, Centre for Psychosocial Medicine, Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Child Public Health Research Section

[3 ] Brandenburg University of Technology, Cottbus-Senftenberg, Institute of Health

[4 ] Eberhard Karls University of Tübingen, Institute of Sports Science

[5 ] Eberhard Karls University of Tübingen, Interfaculty Research Institute for Sport and Physical Activity

[6 ] Nordhausen University of Applied Sciences, Institute for Social Medicine , Rehabilitation, Sciences and Health Services Research

Author notes

Corresponding author Dr. Irene Moor, Martin Luther University Halle-Wittenberg, Medical Faculty, Interdisciplinary Centre for Health Sciences (PZG), Institute for Medical Sociology, Magdeburger Str. 8, 06112 Halle (Saale), Germany, E-mail: irene.moor@ 123456medizin.uni-halle.de

Article

DOI: 10.25646/11876

PMC ID: 10977468

PubMed ID: 38559681

SO-VID: 2310ada2-5d5c-46bf-9eb2-db784d8a7eee

License:

This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date received : 06 October 2023

Date accepted : 27 November 2023