Sex differences in life-course social disadvantage and all-cause mortality: evidence from a longitudinal study from 1996 to 2023.

Authors

Daniel Tarekegn Worede, Alfons Hollederer

Published in

BMC public health. Volume 26. Issue 1. Aug 03, 2026. Epub Aug 03, 2026.

Abstract

Social inequalities in mortality persist in Germany despite high universal health coverage. Yet no study has simultaneously examined sex-specific differences in accumulation, age modification, and life-stage variation in the association between social disadvantage and all-cause mortality across the adult life-course.
We conducted a longitudinal life-course study using 28 years of data from the German Socioeconomic Panel (SOEP; 1996-2023), comprising 112,006 adults and 660,480 person-wave observations. Low socioeconomic status (low-SES), an indicator of social disadvantage, was measured as the number of years spent in the lowest 20% of a composite SES index of education, occupation, and income. Cox proportional hazards models were fitted to estimate (1) accumulation, (2) age-modification, and (3) life-stage variation in the social disadvantage-mortality association for women and men. Results are reported as adjusted hazard ratios (HRs) with 95% confidence intervals (CIs).
Over 684,295 person-years of follow-up, 4,974 deaths occurred. Cumulative social disadvantage was associated with higher mortality risk for both sexes. Among women, each additional year spent in social disadvantage at age 50 was associated with a 13% higher mortality hazard (HR = 1.13; 95% CI: 1.07-1.19). The accumulation gradient was steeper among men (15%; interaction HR = 1.02; 95% CI: 1.01-1.04). The age-modification model indicated that the strength of the social disadvantage-mortality association attenuated with age, but more gradually for men than for women. In the life-stage model, stronger associations were observed in emerging adulthood for women (ages 16-29: HR = 1.34; 95% CI: 1.05-1.71) and in mid-adulthood (ages 45-64: HR = 1.13; 95% CI: 1 .03-1.24) and late adulthood ( ages 65 + : HR = 1.14; 95%CI: 1.00-1.29) among men.
An accumulation of social disadvantage increases mortality hazard for both sexes, but is higher for men. Association decreases with age, strongest in emerging adulthood for women and mid-to-late adulthood for men. These findings underscore the importance of life-course-informed and gender-responsive public health actions to reduce persistent social inequalities in mortality in Germany.

PMID:
42547865
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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