Health Inequalities in German Higher Education: A Cross-Sectional Study Reveals Poorer Health in First-Generation...

University students worldwide experience considerable health challenges. We examined health inequalities in a nationwide, gender-balanced sample of 1105 German students, considering negative (stress, depression, burnout) and positive health outcomes (self-rated health [SRH], well-being) alongside vertical (subjective social status [SSS], parental academic background) and horizontal (gender) determinants. Analyses used bivariate statistics, multivariate regressions, and interaction terms. Higher SSS was associated with better SRH (β = 0.322) and well-being (β = 0.355), and lower stress (β = -0.154), depression (β = -0.127), and burnout (β = -0.219). First-generation students reported highly significant poorer SRH and well-being than students with one (β = 0.114; β = 0.112) or two academic parents (β = 0.162; β = 0.192). Students with two academic parents showed lower stress (β = -0.087, p = 0.007) and burnout (β = -0.099, p = 0.002). Interactions suggest a protective effect of higher SSS on depression (β = -0.219, p = 0.026) and burnout (β = -0.264, p = 0.006), more pronounced among male students, who additionally benefited more from an academic household regarding SRH (β = 0.100, p = 0.044). These findings underscore intersectional and multifaceted inequalities among German students and the need for interventions.