Socioeconomic and sociodemographic differences in the consequences of the COVID-19 pandemic and their impact on self-rated health and mental well-being: results from a cross-sectional study in Germany.

Publication date: Jul 22, 2025

Although the COVID-19 pandemic has demonstrably led to an increase in health inequities, only a few studies have analyzed their underlying mechanisms by taking into account socioeconomic status and sociodemographic differences at the same time. Similarly, only few studies have explored the impact of COVID-19 containment measures on inequities in living conditions, health-related risks, and coping resources. This study aims to address these gaps by exploring the complex associations of socioeconomic and sociodemographic factors with changes in life circumstances, pandemic-related experiences, self-rated health, and well-being among adults living in Germany. A total of 2,123 adults (women: 49. 8%, men: 50. 2%) living in Germany participated in the cross-sectional online study ExCo:Well between July and August 2022. The survey included questions on socioeconomic status, sociodemographic factors, social circumstances, resources and burdens, as well as health outcomes. The data were analyzed using bivariate and multivariable logistic regression analyses. Our results show significant disparities in self-rated health and mental well-being based on socioeconomic status. For sociodemographic differences, the results are mixed, with only women consistently showing worse health outcomes than men. Immigration status played a limited role. Although measures to contain the COVID-19 pandemic more commonly affected the life and work conditions of more privileged participants, socioeconomically disadvantaged participants experienced higher burdens and had fewer coping resources. Logistic regression analyses showed that health inequities decreased when resources and burdens were considered. By covering the whole period of the COVID-19 pandemic, our data allow for an overall assessment of this critical time as well as a better understanding of mechanisms underlying health inequities. Our findings suggest that more important than the number of government-induced social changes is their quality and their potential to negatively impact material and social livelihoods in the long run. To improve health equity, tailored social security and health promotion interventions need to be systematically integrated in pandemic or crisis response plans.

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