Health Disparities
Intersectional Dynamics of Physical and Mental Health Inequalities Across the Life Course: A Longitudinal MAIHDA Analysis of the United Kingdom Household Longitudinal Study Daniel Holman* Daniel Holman Andrew Bell Helena Mendes Constante Mark Green Aneta Piekut Matthew Bennett
The existence of physical and mental health inequalities in the UK according to socioeconomic position, gender and ethnicity is well-established. Increasingly, scholars are applying intersectionality to understand how these axes of inequality layer and interact. However, very little is known about intersectional trajectories across the life course, and how this varies for those in different generational cohorts.
This study applies a highly novel longitudinal MAIHDA (Multilevel Analysis of Heterogeneity and Discriminatory Accuracy) approach to understand intersectional dynamics in physical (SF-12 PCS) and mental (SF12-MCS) health inequalities. MAIHDA nests individuals within their intersectional strata to estimate how much variability in an outcome is attributable to intersectional subgroups, and to assess the nature and extent of intersectional inequalities. The analysis uses data from people aged 15-103 in the United Kingdom Household Longitudinal Study (n=78,991) from 2009-2022. Intersectional variables are ethnicity (10 categories), gender (2 categories), education (3 categories) and generation (5 categories), resulting in 330 intersectional groups.
The findings suggest that mental health shows clear generational effects, whereas physical health is mainly driven by age. Physical health varies more between than within people over time, showing significant intersectional inequalities. Mental health is more volatile within individuals over time, and intersectional inequalities are minimal. Low education women typically experienced the worse health trajectories, and for mental health, this was particularly the case for generation Z. Pakistani and Bangladeshi ethic groups had the worst physical and mental health.
The results suggest a complex picture of mental and physical health over the life course, which can provide valuable information for interventions and policies to target and tailor approaches to address the nuances of health inequalities.
