Gender Differences in Exposure, Coping, and Outcomes of Perceived Unfairness Stress: Evidence from Urban China

Background Perceived unfairness stress is recognized as a chronic social stressor affecting wellbeing globally. In China, rapid socioeconomic change and persistent gender norms make the pathways from unfairness to health outcomes especially complex, yet underexplored. Objectives This research examines gender differences in the associations among perceived unfairness stress (PUS), coping strategies (USC), and health outcomes (USO) among urban Chinese adults. Methods A sample of 2,843 adults aged 18–85 from four provincial capitals was collected using multistage stratified sampling in 2021. PUS was measured across seven life domains. Coping was assessed via an adapted Brief-COPE. USO was operationalized as experiencing at least one of three stress-related symptoms attributed to unfair treatment. Logistic regression models were estimated separately for male and female participants, controlling for socio-demographic covariates. Results Overall, 38.52% of respondents reported USO. For both genders, education and promotion were the most frequently perceived unfair domains; for women, medical/healthcare unfairness ranked third, whereas men reported “other domains.” In stratified analyses, men’s USO were associated with perceived unfairness, and buffered by active coping and support-seeking. In contrast, for women, life stress was a stronger predictor; among coping strategies, only confrontive coping showed a protective association. Conclusions The findings highlight that gender shapes not only exposure to unfairness stress but the meaning and health impact of that exposure. Interventions aiming to mitigate health harms from unfairness must address specific domain-based injustices and bolster coping strategies in gender-appropriate ways. Both structural and psychosocial support are needed.