ArticleBMC public health2026
Gender-patterned associations of exposure, coping, and health outcomes of perceived unfairness stress in urban China.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPerceived unfairness stress (PUS) is recognized as a chronic social stressor affecting wellbeing globally. In China, rapid socioeconomic change and persistent gender norms make the pathways from unfairness to health outcomes especially complex, yet underexplored.
objectivesThis research examines gender-patterned associations among perceived unfairness stress, coping strategies in response to unfairness, and unfairness-related health outcomes among urban Chinese adults.
methodsA sample of 2,843 adults aged 18-85 from four provincial capitals was collected using multistage stratified sampling in 2021. PUS was measured across seven life domains. Coping responses to unfairness-related stress were assessed using a self-reported measure of primary coping strategy. Unfairness-related health outcomes were operationalized as experiencing at least one of three stress-related symptoms attributed to unfair treatment. Logistic regression models were estimated separately for male and female participants, controlling for socio-demographic covariates.
resultsOverall, 33.6% of respondents reported severe perceived unfairness stress and 38.5% reported unfairness-related health outcomes. Education and promotion were the most frequently reported domains of unfairness for both genders; healthcare-related unfairness ranked third among women, whereas men more frequently reported other domains. Stratified analyses revealed gender-patterned associations. After adjustment for life stress and other covariates, severe PUS remained associated with higher odds of unfairness-related health outcomes among men, whereas this association was not observed in women. In contrast, life stress was the only stress indicator consistently associated with unfairness-related health outcomes in the female models. Regarding coping strategies, active coping was associated with a lower likelihood of unfairness-related health outcomes compared with avoidant coping among men, while no comparable pattern was observed among women.
conclusionsPerceived unfairness stress and unfairness-related health outcomes were common among urban adults in China. The findings suggest that coping responses and gendered social contexts may shape how individuals experience and respond to unfairness-related stress. Interventions aimed at reducing perceived unfairness in domains such as education and promotion, together with gender-sensitive stress-management strategies, may help mitigate stress-related health symptoms.
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