The association between physical exercise participation and individual-level relative health deprivation varies by age, period, birth cohort, and population group in China

Abstract Health inequality remains a key concern in public health policy. In this study, health inequality provides the broader public policy context, while individual-level relative health deprivation serves as the empirical outcome and is measured using the Kakwani relative deprivation index based on self-rated health within each survey year. This study examines the association between physical exercise participation and individual-level relative health deprivation using nine waves of repeated cross-sectional data from the China General Social Survey from 2010 to 2023. A cleaned pooled dataset of 77,253 respondents was obtained, and cross-classified hierarchical age–period–cohort models were estimated using a regression sample of 76,827 respondents. In the main regression sample ( N = 76,827), physical exercise participation is consistently associated with a lower relative health deprivation score across four model specifications (Model 1: β = − 0.03656, SE = 0.00182, p < 0.001; Model 4: β = − 0.03433, SE = 0.00866, p < 0.001). The association varies across age, period, and birth cohort. Formal interaction tests further indicate statistically significant group heterogeneity by education, income, urban–rural status, and region. Robustness checks using the original five-level exercise-frequency variable, a restricted sample excluding respondents older than 70 years, alternative 10-year cohort groupings, and ordered logit and ordered probit models with self-rated health as the outcome yield substantively consistent results.