{
  "abstract": "Background Health inequalities by sex/gender, migration, education and income persist across Europe, yet intersectionality-informed research on how these social positions jointly shape self-rated health (SRH) remains limited.Methods We conducted a cross-sectional analysis of the German National Cohort (NAKO; n=179 861). Sex/gender, education and income were combined with three migration characteristics (any migration, Turkish and ethnic German resettler backgrounds) into three 16-strata exposure variables. We used Poisson regression with robust SEs to estimate adjusted frequencies and relative risks of poor SRH, adjusting for age, household size and study site. Departures from additivity were assessed using two-, three-, four-way and total relative excess risk due to interaction (RERI).Results Poor SRH followed a social gradient. Adjusted frequency of poor SRH generally increased with each additional marginalised social position, from 6.3% (95% CI 5.5% to 7.2%) among high education and income migrant men to 22.6% (95% CI 21.3% to 23.8%) among low education and income migrant women. Adjusted frequencies were highest among participants with Turkish background. Joint exposure to female sex/gender, migration and low education and income was associated with risk of poor SRH beyond the sum of individual effects. Total RERIs for four-way intersections were 1.10 (95% CI 0.83 to 1.37) for any migration, 3.09 (95% CI 2.02 to 4.15) for Turkish and 1.62 (95% CI 0.84 to 2.41) for ethnic German resettler backgrounds.Conclusions SRH in Germany exhibits pronounced intersectional inequalities. Individuals occupying multiple marginalised social positions experienced a disproportionate burden of poor SRH, highlighting the importance of intersectionality in population health monitoring.",
  "authors": [
    {
      "affiliations": [
        "Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany",
        "Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Medizin, Ludwig-Maximilians-Universität München, Munich, Germany",
        "Pettenkofer School of Public Health, Munich, Germany"
      ],
      "name": "S Claire Slesinski"
    },
    {
      "affiliations": [
        "Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA",
        "Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Usama Bilal"
    },
    {
      "affiliations": [
        "Research Group Health and Social Inequality, Wissenschaftszentrum Berlin für Sozialforschung gGmbH, Berlin, Germany",
        "Freie Universität Berlin, Berlin, Germany",
        "Einstein Center Population Diversity, Berlin, Germany"
      ],
      "name": "Jan P Heisig"
    },
    {
      "affiliations": [
        "Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany"
      ],
      "name": "Klaus Telkmann"
    },
    {
      "affiliations": [
        "Department of Social Sciences, Health Psychology, University of Mannheim, Mannheim, Germany"
      ],
      "name": "Carolin Marie Callies"
    },
    {
      "affiliations": [
        "Department of Social Sciences, Health Psychology, University of Mannheim, Mannheim, Germany"
      ],
      "name": "Christine Emmer"
    },
    {
      "affiliations": [
        "Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany"
      ],
      "name": "Heiko Becher"
    },
    {
      "affiliations": [
        "Leibniz-Institut fur Praventionsforschung und Epidemiologie—BIPS GmbH, Bremen, Bremen, Germany"
      ],
      "name": "Tilman Brand"
    },
    {
      "affiliations": [
        "Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Salle), Germany"
      ],
      "name": "Nadine Glaser"
    },
    {
      "affiliations": [
        "Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "Volker Harth"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany",
        "Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany",
        "Bavarian Cancer Research Center, Erlangen, Germany"
      ],
      "name": "Anne Herrmann"
    },
    {
      "affiliations": [
        "Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Berlin, Germany",
        "Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany",
        "State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany"
      ],
      "name": "Thomas Keil"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany"
      ],
      "name": "Michael Leitzmann"
    },
    {
      "affiliations": [
        "Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany"
      ],
      "name": "Claudia Meinke-Franze"
    },
    {
      "affiliations": [
        "Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Salle), Germany"
      ],
      "name": "Rafael Mikolajczyk"
    },
    {
      "affiliations": [
        "Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "Nadia Obi"
    },
    {
      "affiliations": [
        "Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany"
      ],
      "name": "Börge Schmidt"
    },
    {
      "affiliations": [
        "Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany"
      ],
      "name": "Julia Schwichtenberg"
    },
    {
      "affiliations": [
        "Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Berlin, Germany"
      ],
      "name": "Stefan N Willich"
    },
    {
      "affiliations": [
        "Prevention and Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie—BIPS GmbH, Bremen, Germany",
        "Health Sciences Bremen, University of Bremen, Bremen, Germany"
      ],
      "name": "Hajo Zeeb"
    },
    {
      "affiliations": [
        "Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany",
        "Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Medizin, Ludwig-Maximilians-Universität München, Munich, Germany",
        "Pettenkofer School of Public Health, Munich, Germany",
        "German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany"
      ],
      "name": "Annette Peters"
    },
    {
      "affiliations": [
        "Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany"
      ],
      "name": "Alexandra Schneider"
    },
    {
      "affiliations": [
        "Department of Population Medicine and Health Services Research, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany",
        "Section for Health Equity Studies and Migration, University Hospital Heidelberg, Heidelberg, Germany"
      ],
      "name": "Kayvan Bozorgmehr"
    },
    {
      "affiliations": [
        "Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Medizin, Ludwig-Maximilians-Universität München, Munich, Germany",
        "Pettenkofer School of Public Health, Munich, Germany"
      ],
      "name": "Eva Rehfuess"
    },
    {
      "affiliations": [
        "Department of Epidemiology & International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany"
      ],
      "name": "Oliver Razum"
    },
    {
      "affiliations": [
        "Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany",
        "Health Sciences Bremen, University of Bremen, Bremen, Germany"
      ],
      "name": "Gabriele Bolte"
    }
  ],
  "title": "Intersectional inequalities in self-rated health in Germany across sex/gender, migration, education and income: a cross-sectional study",
  "uid": "1404e3ba-b0a6-5281-ad25-e474bba133b5"
}