Intersectional inequalities in physical and mental health by sex, gender and immigration in Germany

Abstract

Abstract Background The mapping of migration-related health inequalities remains challenging, since immigrant populations constitute a heterogenous socially constructed group whose health experiences differ by social determinants of health. In spite of the increasing awareness that population mobility and its effects on health are highly gendered, an explicit gender perspective in epidemiology is often lacking or limited. Methods To map health inequalities in Germany at the intersection of sex, gender and immigration status, we used data from the German Socioeconomic Panel (SOEP) and applied an intercategorical intersectional approach conducting multilevel linear regression models. We differentiated between sex (male/female) as reported in the survey and gendered social practices, quantified through a gender score (femininity-masculinity continuum). Results We included 20,897 participants in our analyses. We saw an intersectional gradient for physical and mental health. Compared to the reference group, i.e. non-immigrant men with masculine gendered practices, physical and mental health steadily decreased in the intersectional groups that did not embody one or more of these social positions. The highest decreases in health were observed in the intersectional group of immigrant women with feminine gendered practices for physical health (-1.54 CI -2.41;-0.79) and among non-immigrant women with feminine practices for mental health (-2.71 CI -3.19;-2.14). Conclusions We saw differentiated patterns of physical and mental health along the intersectional axes of sex, gender and immigration status, both for physical and mental health. These findings highlight the relevance of these intersections in describing population health statuses and emphasise the need to take them into account when designing public health policies aiming at effectively reducing health inequalities. Key messages Being a man and having masculine gendered practices were associated with higher mental and physical health scores, for both immigrants and non-immigrants. Adopting an intersectional perspective, which takes into account social positions (e.g. gender, immigration status) and their impact on health inequalities, can help to target public health policies.