Socio-economic patterning of general health among young people and the role of disability: a cross-sectional analysis of the 2021 census

Objectives To examine the association between self-reported health (SRH) and three indicators of socioeconomic position (SEP), and to assess whether disability modifies these relationships. Design Cross-sectional study using nationally representative data from the 2021 Census in England and Wales. Setting and participants 697 728 individuals aged 10–29 years from England and Wales. Primary and secondary outcome measures We examined associations between SRH and: (1) the National Statistics Socio-economic Classification (NS-SEC) of the household reference person (HRP), (2) individual-level NS-SEC, and (3) highest level of completed qualifications. Logistic regression models estimated odds of reporting poor health, adjusting for age, household-level deprivation indicators, region, and disability. Analyses were stratified by sex. Results SRH showed consistent socioeconomic patterning across all three SEP indicators. (1) NS-SEC of the HRP: Young people living in households classified as ‘never worked’ had the highest odds of reporting poor health. Adjustment for disability reduced the odds from 5.2 to 2.8 (95% CI 2.50–3.13) in males and from 3.5 to 2.4 (95% CI 2.11–2.70) in females. (2) Individual-level NS-SEC: Those who had ‘never worked’ also had substantially higher odds. Adjustment for disability reduced the odds from 8.6 to 1.8 (95% CI 1.70–1.98) for males and from 6.7 to 2.3 (95% CI 2.09–2.43) for females. (3) Qualifications : Having ‘no qualifications’ was associated with increased odds of poor health. After adjusting for disability, these reduced from 2.1 to 1.2 (95% CI 1.12–1.29) in males and from 1.8 to 1.4 (95% CI 1.31–1.52) in females. Conclusions Young people who have never worked, are long-term unemployed, or have no qualifications had the highest levels of poor SRH. Disability significantly attenuates these associations, but socioeconomic gradients remain statistically significant. Policies that improve access to education and employment for the most disadvantaged young people may help reduce health inequalities.