Continuing exposure to disadvantageous material and perceived economic factors on self-rated health in different life stages: fixed effects analyses with data from the German Socioeconomic Panel

Abstract

Background
Life course epidemiology explores health disparities over time. The accumulation thesis thereby suggests an add-up of disadvantages, while the adaptation model assumes an adjustment to disadvantageous conditions. Examining the relevance of these accumulation and adaptation processes, the present study analyses continuing exposure to various material and perceived economic factors on self-rated health (SRH) across different life stages.

Methods
All analyses are based on longitudinal data from the German Socio-Economic Panel (SOEP) from 1994 to 2017. Exposure variables, including loan burdens, housing status and quality (material factors) as well as financial and occupational worries, housing and income satisfaction (perceived economic factors), were analyzed dichotomously. Exposure duration was calculated as observed years in exposure for each of the factors, taking only continuous exposure years into account. The analyses were carried out separately for sex and life stages (emerging, early middle & later middle, late adulthood) using fixed effects models to adjust for time-varying covariates.

Results
The analyses showed accumulation processes associated with housing status, financial worries and income satisfaction impacting SRH across most life stages. The effects of continuing exposure to occupational worries, housing satisfaction, housing quality, and loan burdens were more variable, indicating accumulation processes in certain life stages and sex-specific variations.

Conclusions
While predominantly accumulation effects were found for certain factors, others showed more varied patterns. Future research should explore the mechanisms underlying these effects to develop well-timed measures that mitigate the negative health implications of continuing exposures to disadvantageous factors, emphasizing the importance of multiple exposures and later life health effects that may impede healthy ageing.

Full text

Rähseetal. BMC Public Health (2025) 25:446
https://doi.org/10.1186/s12889-024-21135-y
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BMC Public Health
Continuing exposure todisadvantageous
material andperceived economic factors
onself-rated health indierent life stages:xed
eects analyses withdata fromtheGerman
Socioeconomic Panel
Tobias Rähse1* , Matthias Richter1,2 and Anja Knöchelmann1
Abstract
Background Life course epidemiology explores health disparities over time. The accumulation thesis thereby sug-
gests an add-up of disadvantages, while the adaptation model assumes an adjustment to disadvantageous condi-
tions. Examining the relevance of these accumulation and adaptation processes, the present study analyses continu-
ing exposure to various material and perceived economic factors on self-rated health (SRH) across different life stages.
Methods All analyses are based on longitudinal data from the German Socio-Economic Panel (SOEP) from 1994
to 2017. Exposure variables, including loan burdens, housing status and quality (material factors) as well as financial
and occupational worries, housing and income satisfaction (perceived economic factors), were analyzed dichoto-
mously. Exposure duration was calculated as observed years in exposure for each of the factors, taking only continu-
ous exposure years into account. The analyses were carried out separately for sex and life stages (emerging, early mid-
dle & later middle, late adulthood) using fixed effects models to adjust for time-varying covariates.
Results The analyses showed accumulation processes associated with housing status, financial worries and income
satisfaction impacting SRH across most life stages. The effects of continuing exposure to occupational worries, hous-
ing satisfaction, housing quality, and loan burdens were more variable, indicating accumulation processes in certain
life stages and sex-specific variations.
Conclusions While predominantly accumulation effects were found for certain factors, others showed more varied
patterns. Future research should explore the mechanisms underlying these effects to develop well-timed measures
that mitigate the negative health implications of continuing exposures to disadvantageous factors, emphasizing
the importance of multiple exposures and later life health effects that may impede healthy ageing.
Keywords Life course epidemiology, Self-rated health, Disadvantageous factors, Accumulation, Adaptation, Healthy
ageing
*Correspondence:
Tobias Rähse
tobias.raehse@medizin.uni-halle.de
Full list of author information is available at the end of the article
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Background
Life course epidemiology (LCE) aims for a broad under-
standing of the onset and development of adverse health
and health inequalities throughout the life course [1]. For
this, different theoretical models and assumptions have
been developed which are taking social, psychological
and biological risk factors into account. One of the most
well-proven models is the accumulation thesis, which
states that (dis-)advantages longitudinally accumulate
over the life course, resulting in worse health in later life.
is has been shown, e.g., for self-rated health, health-
related quality of life, psychiatric disorders and cardio-
vascular disease [2–6]. Traditionally, research on this
model has measured accumulation by considering paren-
tal or individual educational, occupational or income
position at childhood, young and late adulthood [7].
Another perspective focuses on identifying specific
indicators and (mediating) factors which influence health
throughout the life course, with particular attention to
the time and timing of their occurrence [8]. Sensitive (or
socially-critical) periods represent one way to explore
this perspective, as they highlight how (dis-)advanta-
geous factors act differently across different life stages
[9]. Contrary to critical periods, such as childhood and
adolescence, which are often linked to bio-physiologi-
cal changes that can shape long-term health outcomes,
sensitive periods do not necessarily coincide with these
developments. Instead, they reflect windows during the
life course where individuals may be particularly vulner-
able to social, environmental, or psychological stressors,
regardless of biological maturation [10]. Importantly, this
perspective does not require exposure to be sustained
across the entire life course. Rather, even temporary dis-
advantages during these periods can have long-lasting
health effects.
e adaptation model takes a different approach and
postulates that individuals get used to (dis-)advanta-
geous situations. Health, life satisfaction and well-being
drop at onset of a negative life event, increase afterwards
and reach (almost) initial level, as measured before the
occurrence of the event. is process is observed for
a certain period of time rather than throughout the life
course. Previous studies on life events regarding family,
work and disability focused on time spans up to 7 years
and the immediate effect on health and similar outcomes
[11–16].
For some factors, such as unemployment, evidence
for both accumulating as well as adaptation processes
regarding health outcomes have been found [17–19].
While findings on accumulation processes indicate
that persistent exposure to unemployment can lead
to long-term health deterioration due to cumulative
stressors such as the loss of financial resources and
social contacts, research on adaptation processes sug-
gests that individuals may build resilience through cop-
ing strategies like social support and learning from past
experiences to mitigate negative health impacts. ere-
fore, the question arises whether they are opposing or
rather complementary models. It might also be true
that one model dominates in a certain period, while at
a later point in life it becomes less prominent or even
irrelevant.
Disadvantageous factors have been shown to play a
crucial role in explaining health inequalities in cross-
sectional research [20–25]. Studies on the long-term
effects of these factors may shed a different light on
the role of these exposures, as first results suggest that
material factors are less important if measured repeat-
edly [26]. However, evidence is scarce and it is not
clear whether continuing exposure to disadvantageous
factors affect health more in terms of accumulation
or adaptation and whether this differs with the stud-
ied exposures or the specific life stage in which it was
experienced.
Investigating potential health impacts over a brief
period could serve as a first step in examining accumu-
lation and adaptation processes in a broader context.
erefore, our aim is to study whether
i) continuing exposure to disadvantageous material and
perceived economic factors affects health more in
terms of accumulation or adaptation processes.
ii) the association between continuing exposure to dis-
advantageous material and perceived economic fac-
tors and health varies between different life stages.
Methods
Analyses are based on longitudinal data, structured in
long data format, from the German Socio-Economic-
Panel (SOEP, version 34), an annual interdisciplinary
study of private households in Germany. e SOEP pro-
vides detailed information about the living conditions
and quality of life of the German population [27]. As
respondents’ self-rated health (SRH) has been assessed
since 1994, the data used derived from every SOEP wave
from 1994 to 2017. Participants with less than two obser-
vations were excluded. e upper age limit was set at 75
years in order to avoid bias from selective mortality in
older ages. e final sample included 248,886 observa-
tions from 30,904 women, averaging 12.59 observations
per person and 223,709 observations from 28,421 men,
with an average of 12.51 observations per person. e
sample selection steps can also be drawn in more detail
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from the associated flowchart (Supplementary material
1).
Outcome variable
Self-rated health (SRH) is generally considered to be
strongly associated with morbidity and mortality, and
thus with general health [28–31]. Due to its annual
assessment, it allows to observe continual changes in
respondents’ health status over time. SRH was initially
measured using a five-point scale (very good (1) to poor
(5)). We recoded this variable to a new range from 0
“poor” to 4 “very good” to ensure that higher values indi-
cate better health status.
Life stages
In line with other studies, we decided to analyze four
life stages. Slightly adapted to the societal and cultural
conditions in Germany, these cover the ages from 18 to
32 (emerging adulthood), 33 to 49 (early middle adult-
hood), 50 to 64 (later middle adulthood) and 65 to 75
years (late adulthood). During emerging adulthood, the
prolonged transition to adulthood, individuals need to
deal with several developmental tasks, such as entering
the labor market and transitioning into marriage and
parenthood, which can impact health and well-being
[32]. Early middle adulthood is characterized by the chal-
lenge of balancing career progression with significant
family responsibilities, particularly care for young- and
school-aged children [33], while later middle adulthood
represents a period where children typically gain inde-
pendence, prompting individuals to refocus on personal
and professional development, including reaching career
peaks and preparing for retirement [33]. Finally, late
adulthood encompasses the early years of retirement,
often marked by lifestyle changes and shifting social net-
works [34].
Material andperceived economic factors
All material and perceived economic factors were dichot-
omized, with 0 indicating non-exposure and 1 indicating
exposure to the corresponding factor in the respective
survey year.
Material factors
e variables for assessing material factors were selected
according to their relevance and their ability to capture
relevant dimensions of material well-being.
Loan burdens were selected to cover the financial strain
on persons and households reflected in economic or
even physical pressures they face from loan repayments
[35]. To measure these burdens, observations for which
respondents reported that they are repaying a loan and
that these repayments are no problem were assigned to
the code 0 (“no exposure to burdening loan repayment”).
For observations in which participants stated loan repay-
ing as a minor or major burden, the code 1 was assigned
(“exposure to burdening loan repayment”).
Housing status, an indicator of economic stability and
material security, influencing financial and psychological
well-being [36, 37], was assessed based on the question
of whether a participant is the owner of his residence.
Non-ownership, including all forms of tenancy, was con-
sidered as exposure (code 1), while ownership, regard-
less whether apartment or house, was assigned to 0
(non-exposure).
Housing quality was measured by the degree of need
for renovation of the own residence and including the
values “good condition”, “partial renovation”, “full reno-
vation” and “dilapidated”, as pivotal aspects of material
deprivation [38]. e first category was classified as non-
exposed (0), the following three were summarized as
exposed to poor housing quality (code 1).
Perceived economic factors
We furthermore examined indicators that robustly cap-
ture individuals’ subjective perception of their economic
situation.
To reflect immediate and personal experiences of eco-
nomic vulnerability, which have been shown to affect
mental and physical health [39], economic insecuri-
ties were addressed using questions about financial and
occupational worries with the response categories: “not
concerned at all”, “somewhat concerned” and “very con-
cerned”. e first category was assigned to code 0 for non-
exposure, the latter two to code 1 to indicate exposure
to financial or occupational insecurities, respectively.
Income and housing satisfaction were measured using
ten-point scales, with higher scores indicating higher
satisfaction levels, proven predictors of life satisfaction
and beneficial health [40]. For measuring exposure, we
performed median splits [41]. All scores below median (7
for income, 8 for housing) were classified as below aver-
age satisfaction and assigned to the exposure categories
(1). Values above and exactly at the median were cat-
egorized as (above) averagely satisfied and assigned to 0
(non-exposure).
Given these disadvantageous factors, it is important
to also highlight the specific context of Germany [42].
Germany’s robust social welfare system provides a wide
range of protections, including nearly universal access to
healthcare, unemployment benefits and public pensions,
compared to less extensive welfare systems. Additionally,
housingownership may not carry the same weight in the
German context due to the relative security and afford-
ability of long-term renting. Moreover, student loan debt,
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that often contributes to long-term financial strain is far
less prevalent in Germany. While these safety nets may
buffer individuals from extreme material deprivation,
they are not expected to eliminate the effects of continu-
ing exposure to disadvantageous factors.
Exposure duration
For each of the factors, observed years in exposure were
added up, taking only continuous exposure years into
account. If a participant was not exposed for one or more
years or if no information was available, the exposure
duration count was set to zero and restarted once a new
exposure has been observed. Regarding accumulation,
research on occupational hazards indicates that health
effects may not manifest in the same way with inter-
rupted exposure [43] and allostatic load tends to increase
if exposure persists [44].
However, this approach also seems suitable for iden-
tifying adaptation processes. If exposure is intermittent,
improvements in health status during non-exposure
periods might merely reflect recovery due to the (tem-
porary) removal of disadvantageous factors, rather than
actual development of adaptation strategies. For example,
research on stress adaptation highlights that sustained
stress (rather than intermittent) provides a clearer indica-
tion of whether individuals develop effective coping mech-
anisms or not [45]. By focusing exclusively on continuous
exposure, we therefore ensure that observed changes in
SRH can be more reliably attributed to either accumula-
tion of risk or to genuine adaptive strategies, thus facilitat-
ing a better comparison of these competing concepts.
Due to this approach, exposure durations which enclosed
the entire observation period of up to 24 years occurred
very rarely. For most factors no valid statements could be
made beyond a continuous exposure period of 15 years,
why we decided to limit the plotted associations between
exposure duration and SRH to a maximum of 15 years.
Control variables
To avoid bias from confounding variables, all performed
models were adjusted for potential covariates such as com-
ponents of social environment or socioeconomic position.
Regarding social environment, respondents’ fam-
ily status (single, non-marital partnership, married) and
the presence of a partner, as well as children (under the
age of five years) in the household were considered. We
further controlled for the region of residence (eastern vs.
western Germany). Indicators of socioeconomic position
were employment (full-time, part-time, none, pensioned,
in education) and income position. e latter was meas-
ured using income quintiles, whereby the top quintile was
associated with a high, the bottom one with a low and the
middle three with a medium income position [46].
Statistical analyses
e associations between disadvantageous factors and
SRH are likely confounded by additional covariates,
which cannot be easily controlled for (e.g., personal-
ity traits). To provide a clear and less biased view, fixed
effects (FE) models were considered as the most suitable
method for the statistical analyses. Since FE-models are
implicitly controlling for any time-constant factor, only
time-varying confounders remain to be observed [47].
erefore, exposure towards all material and subjec-
tive economic factors as well as all covariates described
in the previous section were treated as time-varying and
included in the respective models accordingly. Aver-
age marginal effects (AME) and corresponding marginal
effect plots were employed to provide information on the
average change in the dependent variable (SRH) when
the independent variables (disadvantageous factors)
change from 0 to 1.e tabulated results of all FE-AME-
models can be found in the Supplementary material 2
(App. Tables1–14). All analyses were carried out sepa-
rately for sex and life stages, to show potential differences
in trajectories, given that sex-specific factors may influ-
ence health outcomes differently across the life course, as
shown, e.g., for mental health aspects or allostatic load
[48, 49]. Panel-robust standard errors were used in all
estimated models, to adjust for clustering of observations
within persons. All analyses were conducted using Stata
version 18.
Results
Description
Descriptive statistics for the analysis are given in Table1.
Individuals in the final sample had a mean age of 45.0
years (females) and 45.4 years (males), and reported
similar, moderate levels of SRH (women 2.41; men 2.49).
e majority of the observations for both sexes were in
early middle adulthood (women 38.26%; men 36.59%),
followed by later middle (women 24.91%; men 26.19%),
emerging (women 23.57%; men 23.38%) and late adult-
hood (women 13.26%; men 13.85%).
Average exposure durations to the disadvantageous
factors appeared largely similar for both sexes. While
men experienced slightly longer exposure to factors
such as occupational worries (women = 1.44 years;
men = 1.70 years) as well as housing (women = 0.97;
men = 1.00) and income dissatisfaction (women = 1.53;
men = 1.54), women experienced longer exposure dura-
tions regarding loan burden (women = 1.55; men = 1.52),
non-ownership (women = 2.98; men = 2.78), bad housing
quality (women = 1.00; men = 0.99) and financial worries
(women = 3.52; men = 3.25).
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Table 1 Descriptive statistics of the sample over the entire observation period, by sex: German Socio-Economic Panel 1994–2017
Range Women
Mean(SD) Men
Mean(SD) Women
%Men
%
Age 18 75 45.02
(15.16) 45.40
(15.37)
Self-rated health 0 4 2.41
(0.95) 2.49
(0.93)
Life stages
Emerging adulthood 0 1 23.57 23.38
Early middle adulthood 0 1 38.26 36.59
Later middle adulthood 0 1 24.91 26.19
Late adulthood 0 1 13.26 13.85
Material and Perceived economic factors (years
of exposure)
Exposed to loan burden 0 12 1.55
(1.76) 1.52
(1.77)
Exposed to non-ownership 0 24 2.98
(4.51) 2.78
(4.41)
Exposed to bad housing quality 0 22 1.00
(2.25) 0.99
(2.25)
Exposed to financial worries 0 24 3.52
(4.38) 3.25
(4.23)
Exposed to occupational worries 0 24 1.44
(2.61) 1.70
(2.87)
Exposed to housing dissatisfaction 0 24 0.97
(2.13) 1.00
(2.22)
Exposed to income dissatisfaction 0 24 1.53
(2.86) 1.54
(2.90)
Employment status
Full-time employment 0 1 26.57 61.22
Part-time employment 0 1 28.17 5.52
Unemployed 0 1 21.92 8.76
Pensioned 0 1 16.71 17.26
In education 0 1 6.63 7.24
Income position
Low income (income quintile 5) 0 1 21.88 18.40
Medium income (income quintiles 4–2) 0 1 59.33 60.06
High income (income quintile 1) 0 1 18.79 21.54
Social environment
Children living in household 0 1 13.28 12.69
Partner living in household 0 1 25.42 27.68
Marital status
Single (incl. divorced) 0 1 18.47 16.75
Married 0 1 63.96 66.87
Non-marital partnership 0 1 17.56 16.39
Residency
East Germany 0 1 23.29 23.56
Observations 248,886 223,709
Persons 30,904 28,421
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Investigating continuing exposures onSRH: FE‑models
Loan burden
Negative associations of exposure to loan burdens with
SRH were already evident in emerging adulthood (Fig.1).
Initially, the effect was rather small for both sexes. For
men, a decline in SRH could be observed until 6 years of
exposure with an additional steep decline after 9 years of
continuing exposure to loan burdens. For women, a nega-
tive effect could be seen after more than 5 years of expo-
sure duration, followed by a steep incline after 8 years
and a recurrent negative impact after 9 years.
In early middle adulthood, significant associations were
found only for the longest exposure durations among
men. For women a quite consistent, but rather mod-
est, trend of accumulation of disadvantages regarding
their SRH due to loan burdens was observed. Neither
for men nor for women, hardly any reliable effects indi-
cating accumulation and/or adaptation processes could
be found in later middle adulthood. Similar results were
found for men in late adulthood, whereas insufficient
data was available for women in this life stage to estimate
valid margins.
Housing status
Initially, non-ownership had a positive effect on SRH,
whereby this correlation is particularly clear for early
and later middle adulthood individuals and lasting up
to an exposure period of 4 years (Fig.2). Afterwards, the
absence of home ownership was negatively associated
with SRH in all life stages. is significant and highly
consistent negative association became stronger with
increasing exposure, suggesting accumulation processes.
For women, these effects were already significant after
a shorter exposure period and partly even more pro-
nounced than for men, except in later middle adulthood.
Fig. 1 Fixed-effects regression for impact of continuing exposure to loan burden on SRH in different life stages (presented as AMEs). Adjusted
for employment status, income position, marital status, social environment, residency
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Housing quality
In emerging and late adulthood, exposure to poor hous-
ing quality seemed to be less relevant for SRH, whereas
in early and later middle adulthood, stronger associa-
tions emerged (Fig.3). Men appeared to be more affected
in terms of accumulation of disadvantages, which was
reflected in decreasing SRH, especially for continuing
exposure for 10 or more years. Among women, similar
trends were found in these two life stages, although not
as prominent.
Economic insecurities
Regarding economic insecurity, substantial and per-
sistent accumulation effects were evident regarding
financial worries, which increased with longer exposure
duration (Fig. 4a). e process was less pronounced
in late adulthood, especially for men. e exposure to
financial worries was strongly negatively associated with
SRH, with longer exposure beingassociated with greater
deterioration in health. ese associations were statis-
tically significant for men and women over the entire
observation periods in the first three life stages, most
prominent for early middle adulthood.
Considering occupational worries, no valid statements
about late adulthood could be made, especially for men
where no margins were estimable at all, since the major-
ity of individuals in this life stage were already retired
(Fig.4b). In emerging adulthood, however, adverse effects
of long-term exposure to occupational worries on SRH
were seen for men, but merely so for women at this stage.
In early middle adulthood a growing decline of SRH with
increasing exposure for durations up to seven years could
be seen. For men, this effect was also observed for even
longer continuing exposure (accumulation). In women,
the SRH scores tended to return to the initial level with
increasing exposure, suggesting, if at all, an adapta-
tion process, followed by a recurrent decline in SRH
after 11 years of exposure. In later middle adulthood,
Fig. 2 Fixed-effects regression for impact of continuing exposure to housing non-ownership on SRH in different life stages (presented as AMEs).
Adjusted for employment status, income position, marital status, social environment, residency
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the associations were less strong overall and the sex dif-
ferences less prominent. Yet, a negative breaking point
starting at an exposure duration often years, after which
SRH levels dropped significantly with further exposure
was observed, but only in men.
Housing andincome satisfaction
In emerging adulthood, below-average housing satisfac-
tion initially affected men’s and women’s SRH similarly,
with significant, modestly changing SRH-trajectories for
exposure durations of up to ten years (Fig.5a). After that,
men’s SRH scores became insignificant, while women’s
SRH scores began to decline (sharply) with each addi-
tional exposure year, indicating accumulation.
In early middle adulthood, exposure to below-average
housing satisfaction was associated with a consistently
significant decrease of SRH for both sexes, which became
stronger with increasing exposure duration, again sug-
gesting the presence of accumulation processes. A similar
development was seen in later middle adulthood, with
associations being more pronounced in men, especially
at longer exposure durations. For women, the same over-
all trend was evident, but only significant for exposure
durations up to eight years, with inconsistencies thereaf-
ter. In late adulthood, effects were highly variable, indi-
cating neither accumulation nor adaptation.
Similar to housing satisfaction, negative associations
between below-average income satisfaction and SRH
were already found in emerging adulthood for both
sexes, albeit again rather modest in size (Fig. 5b). Con-
tinuing exposures in early and later middle adulthood
were strongly associated with substantial declines in
SRH, indicating accumulation, despite an intermediate
steep incline between eight and ten years of exposure
for women in later middle adulthood. In late adulthood,
these associations were less strong and barely substantial
again, especially among men.
Fig. 3 Fixed-effects regression for impact of continuing exposure to bad housing quality on SRH in different life stages (presented as AMEs).
Adjusted for employment status, income position, marital status, social environment, residency
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Fig. 4 a Fixed-effects regression for impact of continuing exposure to financial worries on SRH in different life stages (presented as AMEs). Adjusted
for employment status, income position, marital status, social environment, residency. b Fixed-effects regression for impact of continuing exposure
to occupational worries on SRH in different life stages (presented as AMEs). Adjusted for employment status, income position, marital status, social
environment, residency
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Fig. 5 a Fixed-effects regression for impact of continuing exposure to below-average housing satisfaction on SRH in different life stages (presented
as AMEs). Adjusted for employment status, income position, marital status, social environment, residency. b Fixed-effects regression for impact
of continuing exposure to below-average income satisfaction on SRH in different life stages (presented as AMEs). Adjusted for employment status,
income position, marital status, social environment, residency
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Discussion
Accumulation processes were seen for the majority of
material and perceived economic factors and SRH. is
association was particularly strong for housing status
and financial worries. Contrary to Groeniger etal., we
did not see a reduced relevance of these material factors
when measured longitudinally [26]. is discrepancy
might be attributed to the differing outcomes considered
(SRH vs. mortality), as Groeniger etal. suggest that mate-
rial disadvantages tend to exert more indirect effects on
mortality, which may initially manifest in poorer (sub-
jective) health [26]. Regarding life stages, early and later
middle adulthood showed the most noticeable accumula-
tion processes, with continuing exposure to material and
perceived economic factors significantly impacting SRH.
is continuing disadvantage could exacerbate health
inequalities as individuals, especially during these peri-
ods, are facing societal pressures to meet professional
and economic goals. ese results are in line with find-
ings from previous studies which showed the impor-
tance of accumulation processes for health inequalities,
focusing on indicators of socioeconomic position [2–6].
In contrast, continuing exposure to material and per-
ceived economic factors seems to be less relevant for self-
rated health in emerging and late adulthood. Our study
extends the existing research on life course epidemiology
as well as on material and perceived economic factors, as
we were able to show that not only income or education
are important for accumulation of health disadvantages,
but that perceived economic and material factors are also
relevant in a longitudinal perspective.
Housing status emerged as a crucial material factor influ-
encing SRH across all life stages. e absence of hous-
ingownership exhibited a consistent negative association
with SRH after an initial short-term positive effect.Hous-
ing status might act as a proxy for various dimensions of
well-being, such as quality of life or as a status symbol,
reflecting a person’s achievements and social standing
within a community [36, 37]. Home ownership can be
perceived as a psychological anchor, fostering a feeling of
security and stability [50], as homeowners are less likely to
live in deprived neighborhoods than renters and/or more
invested in improving neighborhood conditions [51].
Furthermore, the pursuit of home ownership is likely to
be seen as a life goal that individuals aspire to and may
work towards throughout their life course [52]. e ongo-
ing inability of reaching this goal might be burdensome
and could explain the negative effect on SRH. Along
with the absence of a cushioning effect of ownership as
potential sales asset and thus retirement provision [53],
this may contribute to the enduring importance of home
ownership into late adulthood, where not achieving this
goal continues to be important for SRH. e short-term
positive effects of non-ownership may stem from the ini-
tial burdens of starting owners due to planning, financial
and construction necessities.
For perceived economic factors, income and housing
satisfaction seemed most relevant. e subjective percep-
tions of satisfaction persists even when controlling for
objective factors such as income or occupational posi-
tion, in line with prior research [40, 54]. Social compari-
son with others seems to play a pivotal role for explaining
these results, especially for income satisfaction [55]. Per-
sons feeling inferior in social comparison may tend to
avoid such comparisons and become socially isolated [56].
Regarding housing satisfaction, it has been evidenced that
persons living in deprived neighborhoods suffer from
a lack of crucial resources such as healthy lifestyles and
food options as well as social support which, alongside
social isolation, can negatively impact SRH [57, 58].
In general, the impact of continuing exposure to mate-
rial and perceived economic factors was more pro-
nounced in early and later middle adulthood. is might
be explained by various personal and societal expec-
tations and norms which are dictating certain profes-
sional, economic and familial goals that need be achieved
within these stages to be considered ‘successful’ [33, 59].
e feeling of not having achieved these goals fully or in
time can be perceived as a burden, exacerbating stress on
the individuals, which might result in worse health. e
explanation for heterogenous results regarding emerg-
ing adulthood can also be found in the characteristics of
this life stage. While society has clearly defined require-
ments regarding achievements in early and later middle
adulthood, they are less important in emerging adult-
hood. Here, persons are expected to follow their indi-
vidual paths to lay the foundation for a future career
and an organized family life, thereby establishing the
groundwork for the requirements of early and later mid-
dle adulthood [60]. It is predictable and inevitable that
this is accompanied by lower income and lower housing
quality. Hence, it can be assumed that these factors have
a less significant impact on immediate health, as dissat-
isfaction with income or living conditions, or the burden
of debt, might be viewed as temporary, with the prospect
of improvement in future life mitigating negative health
effects. Regarding late adulthood, the diminished rele-
vance of continuing exposure to disadvantageous factors
for self-rated health in this life stage may be explained by
the reduced effectiveness of cultural resources, includ-
ing material and (perceived) economic factors, due to
decreasing biological plasticity associated with higher age
[61]. Moreover, research suggests that subjective health
perceptions tend to become less reliable or relevant com-
pared to objective health status in late adulthood, as indi-
viduals in this stage report greater life satisfaction, which
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Page 12 of 15
Rähseetal. BMC Public Health (2025) 25:446
can result in contradictory effects, with some older adults
reporting improvements in subjective well-being over
time, even if their objective health declines [62]. How-
ever, delayed effects of continuing exposures to past dis-
advantages may still play a role in shaping older adults’
health status and perception but may not have been fully
captured due to limitations in sample size, as discussed in
the following limitations section.
Sex differences were only seen for some of the studied
factors and mainly in early to later middle adulthood with
longer times in disadvantages, with men showing worse
health than women. is might be due to the still existing
typical role expectations, with men being more likely to
be expected to fulfill job and income related obligations,
whereas women are oftentimes responsible to provide
a representable home [63]. is reflects in our results
where women only have worse health than men regard-
ing the need for renovation.
Strengths andlimitations
e SOEP is representative of the German population
with a high number of respondents and covers a long
observation period. e substantial number of partici-
pants allowed us to explore the relationship between
perceived economic and material factors and SRH across
various life stages for men and women respectively. Due
to the continuous and consistent collection of the data we
were able to address the importance of these factors lon-
gitudinally. We used Fixed-effects regression to analyze
the impact of material and perceived economic factors
on SRH. erefore, we were able to account for all unob-
served time-invariant factors, which might influence the
studied associations, such as personality traits.
We decided not to add up the observed years of expo-
sure over the entire life course, but to take only con-
tinuous exposure years into account, as health related
recovery might occur in non-exposed years.While allow-
ing a more precise examination of continuing exposures,
this approach may underestimate that a relapse in expo-
sure could pose an additional weight on the disadvan-
tage and could lead to persons being considered multiple
times, if after (at least) one year of non-exposure another
exposure period was observed for the same participant.
Due to the upper age restrictions, late adulthood has
the lowest number of cases. Consequently, the observed
effects for this stage are modest in size and less substan-
tial – considering people over this age limit could have
led to different or more robust results. However, we con-
sidered imprecision due to age-associated multimorbid-
ity and mortality to be a major confounding factor and
therefore decided to use an upper age limit for the inclu-
sion of observations.
While our methodical approach of focusing exclusively
on continuing exposure aims to compare the presence
and extent of accumulation and adaptation processes
under equal conditions, our analyses primarily provide
insights into the accumulation of risk and may not fully
capture the processes of adaptation. As a result, alterna-
tive methods, e.g., as used by Clark et al. or Luhmann
etal. might be more suitable for comprehensively identi-
fying adaptation processes [13, 15].
Moreover, the non-availability of certain material, per-
ceived and behavioral indicators, due to inconsistencies
and data gaps in the SOEP dataset, along with the lack
of consideration for the potentially enhancing effects of
multiple exposures, may limit the comprehensiveness of
our analyses. e same applies to potential bias intro-
duced by the possibility of control variables succeeding
exposure variables in some individual cases.
Conclusion
Our findings shed light on the role of material and per-
ceived economic factors for SRH from a longitudinal
perspective, suggesting that health is more affected by
continuing exposure to disadvantages during certain life
stages, emphasizing that the timing and persistence of
these factors can profoundly influence health outcomes.
is slightly points towards the existence of sensitive
periods marked by timing-dependent vulnerability also
besides the biophysical dimension of critical periods. For
some of the analyzed factors, most noticeable for hous-
ing status, financial worries and income satisfaction, con-
tinuing disadvantage was associated with a deterioration
in health, indicating accumulation processes, while no
reliable effects were discernible supporting the adapta-
tion model. is has been found for almost all life stages,
most pronounced in early and later middle adulthood. For
other factors, such as occupational worries, housing sat-
isfaction and quality or loan burdens, paths are more het-
erogeneous. However, they also primarily tend towards
accumulation processes or have no impact on SRH at all.
We did not find patterns of sex-related differences other
than that for some factors steeper accumulation processes
were shown for men in early and later middle adulthood.
Future research should delve deeper into the mecha-
nisms driving these patterns, particularly focusing on
how prolonged exposure to disadvantageous factors
over the life course influences health outcomes, to offer
more effective strategies for reducing health dispari-
ties. Building on our results, potential avenues for such
interventions could be, for instance, policies aiming at
improving housing conditions, reducing income inequal-
ity or strengthening supportive communities, to tar-
get deprived neighborhoods and social isolation, which
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Page 13 of 15
Rähseetal. BMC Public Health (2025) 25:446
appear to be key mechanisms behind the most severe dis-
advantageous factors of housingand income satisfaction
as well as financial worries.
While the present study focuses on quite immediate
health effects, investigating long-term effects seems also
crucial because as risk factors might coincide and inter-
act with each other in the long-term, their effects could
reinforce, exacerbate health issues and thus significantly
reduce the likelihood of healthy aging. By understand-
ing these long-term processes, we can better identify not
only avenues but also promising time windows for effec-
tive interventions that could mitigate such adverse health
and agingimplications.
Abbreviations
LCE Life Course Epidemiology
SRH Self-Rated Health
SOEP Socio-Economic Panel
SD Standard Deviation
FE Fixed Effects
AME Average Marginal Effects
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s12889- 024- 21135-y.
Supplementary Material 1.
Supplementary Material 2.
Authors’ contributions
All authors contributed to the study conception and design. Conceptualiza-
tion: T.R., A.K.; Writing—original draft preparation: T.R., A.K.; Writing—review
and editing: T.R., A.K., M.R.; Funding acquisition: M.R., A.K.
Funding
Open Access funding enabled and organized by Projekt DEAL. This study is
part of the project “Accumulation, health and health inequalities. The impor-
tance of life course processes and risk profiles”, which is funded by the German
Research Foundation (DFG), with grant agreement number No. RI2467/2–2.
Data availability
The raw data contained in this manuscript are not openly available due to
data protection restrictions of the German Institute for Economic Research
(DIW), which collects and provides the SOEP data. SOEP data are available free
of charge for scientific use from the DIW at https:// www. diw. de/ en/ diw_ 01.c.
601584. en/ data_ access. html after signing a data distribution contract. Data
transformation files and codes are available from the corresponding author
upon reasonable request.
Declarations
Ethics approval and consent to participate
Because we involved only secondary analysis of anonymized data, ethical
approval was not required. The data have been collected in accordance with
German data protection laws.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Author details
1 Institute of Medical Sociology, Interdisciplinary Centre for Health Sciences,
Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale),
Saxony-Anhalt, Germany. 2 Department Health and Sport Sciences, School
of Medicine and Health, Technical University of Munich (TUM), Munich,
Germany.
Received: 11 June 2024 Accepted: 18 December 2024
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