ArticleBMC public health2026
Sex differences in life-course social disadvantage and all-cause mortality: evidence from a longitudinal study from 1996 to 2023.
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
backgroundSocial 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.
methodsWe 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).
resultsOver 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. CONCLUSION/OUTLOOK: 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.
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