Health Inequalities in German Higher Education: A Cross-Sectional Study Reveals Poorer Health in First-Generation University Students and University Students with Lower Subjective Social Status

Background Health challenges are highly prevalent among university students worldwide. To gain a more nuanced understanding and address research gaps, we examined health inequalities in a nationwide, gender-balanced sample of German students, considering both negative and positive health outcomes as well as horizontal and vertical social determinants. Methods A cross-sectional survey of 1,105 students assessed self-rated health (SRH), well-being (WHO-5), stress (SOS-X-G), depression (PHQ-8), and burnout (MBI-SS). Vertical determinants included subjective social status (Mac Arthur Scale) and parental academic background, while gender constituted the horizontal determinant. Data were analyzed using bivariate statistics, multivariable linear regression models, and interaction analyses to examine gender moderation. Results were adjusted for age, migration background, main source of income, living situation, type of university, field of study, and semester. Results Higher subjective social status was associated with better self-rated health (β = 0.322, p < 0.001) and well-being (β = 0.355, p < 0.001), as well as lower levels of stress (β=-0.154, p < 0.001), depression (β=-0.127, p < 0.001), and burnout (β=-0.219, p < 0.001). First-generation students reported poorer self-rated health and well-being than students with one (β = 0.114, p < 0.001; β = 0.112, p < 0.001) or two academic parents (β = 0.162, p < 0.001; β = 0.192, p < 0.001). Compared to first-generation students, students with two academic parents had lower scores of stress (β=-0.087, p = 0.007) and burnout (β=-0.099, p = 0.002). Significant interaction terms suggest a protective effect of higher subjective social status on depression (β=-0.219, p = 0.026) and burnout (β=-0.264, p = 0.006), which was less pronounced for female than for male students. In addition, male students benefited more from an academic household in terms of self-rated health (β = 0.100, p = 0.044). Conclusions Health inequalities among German university students were observed regarding subjective social status and first-generation status, with additional gendered patterns. These findings highlight the need for an intersectional framework to understand health inequalities among students and for multi-level interventions to address them.