Health behaviors, which range from dietary practices to physical activity, are well-acknowledged as significant determinants of population health and its disparities [1, 2]. These behaviors do not operate in isolation; they are shaped by a complex interplay of individual, interpersonal, and societal factors [3]. Among these, socioeconomic status (SES) stands out as a particularly crucial factor [4, 5]. Consistent research findings have shown a marked gradient in health behaviors across different socioeconomic groups. It is often observed that individuals from less advantaged socioeconomic backgrounds engage less in health-promoting behaviors and are more susceptible to behaviors that compromise their health [6]. This raises particular concerns given the instrumental role of health behaviors in preventing chronic diseases, promoting longevity, and improving the quality of life [7].
Physical activity constitutes a health behavior of paramount importance. It stands as a significant determinant of health, with adequate levels of physical activity associated with decreased prevalence and incidence of chronic diseases such as obesity, cardiovascular disease, and type 2 diabetes [8–12]. In addition to the direct physiological advantages, physical activity is correlated with enhanced mental health and cognitive function [13, 14]. Regular engagement in physical activity has been associated with extended lifespan and reduced mortality risk, presumably due to an amalgamation of the aforementioned benefits [15–17].
Despite these notable benefits, a substantial segment of the population remains physically inactive, a trend that seemingly follows a social stratification [5, 6, 18–20]. The existing body of literature consistently demonstrates that SES plays a significant role in determining the levels of physical activity across diverse populations. Individuals with higher SES are frequently correlated with greater physical activity levels [21–24]. Moreover, Elgar et al. (2015) revealed that in developed countries, children whose parents have lower education levels typically exhibit lower levels of physical activity [25].
The influence of SES on physical activity appears to operate through both direct and indirect mechanisms. Direct mechanisms may encompass factors such as the financial capability to afford sports club memberships or access to secure and suitable environments for physical activity [22, 24, 26, 27]. Individuals with higher income often reside in neighborhoods abundant with recreational facilities and fewer safety issues, leading to increased opportunities for physical activity [28]. Indirect mechanisms can involve factors related to education, health and fitness knowledge, and societal norms about physical activity [5, 29, 30]. For example, higher education levels correlate with a greater understanding of the benefits of physical activity, culminating in higher activity levels [31].
However, the relationship between SES and physical activity is intricate, with the influence of SES potentially varying across diverse demographic characteristics. Specifically, both age and gender have been singled out as potential mediators in the SES-physical activity relationship. Contemporary literature reveals a gender disparity, demonstrating that women of lower SES are less likely to engage in physical activity compared to their male counterparts [32–35]. Women of lower SES, confronted with gender and economic inequalities, engage in less leisure-time physical activity compared to men [36, 37]. However, the intersectionality of gender and SES in their influence on physical activity has been relatively underexplored, leaving a fragmented understanding in the existing body of literature.
The influence of SES on physical activity is not only gender-dependent but also age-related. The association between SES and physical activity tends to intensify with age [38, 39]. Often, older adults of lower SES demonstrate decreased physical activity levels [40], potentially due to hindrances such as unsafe neighborhoods or lack of recreational facility access [41–43]. Age-related factors like retirement, social isolation, or chronic conditions may further interact with SES, consequently impacting physical activity levels [44]. However, some studies suggest that SES-related inequalities in health behaviors may diminish with age due to factors such as retirement and shifts in health and disability status [45–47]. Nonetheless, the influence of SES on physical activity appears to remain relatively stable across various age groups, with individuals of lower SES consistently exhibiting lower levels of physical activity [48, 49].
Moreover, studies investigate the intersectionality of SES, gender, and age in relation to physical activity. Originating from feminist theory, the concept of intersectionality recognizes the interwoven nature of social categorizations such as race, class, and gender [50]. The intersectional impacts of gender and age on the SES-physical activity relationship acknowledge the interconnected nature of these sociodemographic factors. In other words, gender and age don't act independently but interact in ways that can diversely shape health behaviors depending on one's SES. This approach acknowledges that individuals' experiences and behaviors are influenced by multiple, interconnected social categories and identities [50, 51]. For example, older women may encounter a “double burden” of gender and age discrimination, affecting their access to health resources and health behaviors [52–54]. Some studies indicated that the impacts of SES on physical activity vary across age and gender groups. Younger, higher-SES women were more likely to engage in physical activity than their lower-SES counterparts, though this discrepancy diminished with age [55]. Low SES was associated with decreased physical activity in older men, but not in older women, suggesting a gender-specific influence of SES on physical activity in older adults [56]. One study found that the impact of SES on health behaviors was strongest among young, less educated women and older, more educated men [31].
Despite these findings, the research examining the intersectional impacts of gender, age, and SES on physical activity remains scarce. A significant proportion of studies have considered these factors separately or in pairs, but few have assessed their combined impacts. Grasping these intersectional impacts can facilitate the design of targeted and effective public health interventions, which contributes towards reducing health disparities and promoting health equity [57]. Furthermore, the majority of research in this area has been conducted in Western countries, leading to questions about the applicability of these findings in different cultural and socioeconomic contexts. Intersectionality is significantly influenced by societal norms and cultural expectations. There’s a demand for more comprehensive studies that simultaneously consider these factors to fully comprehend their intertwined influences on physical activity in non-Western countries. The investigation of intersectional influences of SES, gender, and age on physical activity is particularly pertinent in the Chinese context, given its unique socio-cultural factors, rapid urbanization, demographic transitions, and health disparities.
This study endeavors to address these research gaps by examining the intersection of socioeconomic status, physical activity, gender, and age. The primary research question proposed is: How does the relationship between socioeconomic status and physical activity differ across various gender and age groups?
The hypotheses are as follows:
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Lower socioeconomic status correlates with reduced levels of physical activity.
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The adverse effect of lower socioeconomic status on physical activity is more marked in women older adults.
Comprehending these relationships could bear substantial implications for public health policy. If our hypotheses are validated, it may suggest the necessity for interventions tailored to not only socioeconomic status but also gender and age. Moreover, our findings could contribute insights into the mechanisms that drive health disparities, laying a foundation for more effective and equitable health promotion strategies.