Poverty and health – does parenthood matter? Trends in income inequality in self-rated health among parents and non-parents in Germany from 2009 to 2024

BACKGROUND: Income inequalities in health are a major public health issue in modern societies. This study investigated an understudied topic by comparing trends in income inequalities in self-rated health (SRH) between parents and non-parents. METHODS: We used data from eight surveys of the GEDA study series (2009-2023) and from the first survey of the RKI Panel (2024), including a total of 106,399 randomly sampled participants aged 25-59. Age-adjusted prevalence of good SRH was calculated for each cross-section stratified by income groups and parental status. Moderation analyses using Poisson regressions with three-way interactions between income, parental status and survey were conducted. Trends in income-related health inequality were analysed based on the Slope Index of Inequality and the Relative Index of Inequality stratified by parental status. RESULTS: In 2009, 75.7% of women and 77.7% of men reported good SRH. For the total sample, no significant changes in good SRH were observed until the onset of the COVID-19 pandemic, when a notable increase was recorded (women: 80.2%, men: 81.9%). In 2022, the prevalence returned to pre-pandemic levels and reached its lowest point in 2024 (women: 68.1%, men: 71.6%). Non-parents and those at risk of poverty were less likely to report good SRH. The moderation analysis revealed a decline in good SRH among those at risk of poverty, particularly in non-fathers (from 2014/15 onwards) and non-mothers (after 2014/15). A decline in good SRH was also observed among mothers at risk of poverty in 2023/24. These findings were confirmed by the results on absolute and relative income-related inequalities in SRH. CONCLUSIONS: Even before the pandemic, income-related health inequalities in Germany were increasing to the detriment of non-parents at risk of poverty. This could be due to the prolonged strain on this group caused by the ongoing polycrisis. Parenthood may buffer some of the stress associated with poverty, particularly in women. However, selection effects could also be at play, meaning that people in poor health are less likely to become parents or earn higher incomes. To identify health trends early on and promote targeted policy interventions to improve the health of people living in poverty, health inequalities should be regularly monitored for different population groups.