Adolescent sports participation failed to mitigate entrenched class-based health inequalities across the life course, as evidenced by a significant three-way interaction between social class, sports participation, and age (β -0.0409, p<0.05).
Cohort (n=39,672)
Does physical activity participation mitigate class-based health disparities across the life course?
Universal sports-promotion strategies are insufficient to reduce entrenched health inequalities, as the health benefits of physical activity vary significantly by social class.
Effect estimate: β -0.0409
p-value: p=<0.05
Purpose Health inequalities rooted in social stratification remain a persistent structural public-health challenge. While physical activity is recognized as a health-enhancing behavior, limited longitudinal evidence exists on how its effects vary across social classes. This study examines the life-course interactions among social class, physical-activity participation, and aging, and evaluates whether youth physical activity mitigates class-based health disparities. Methods Data were drawn from five waves (1997, 2000, 2004, 2006, and 2015) of the China Health and Nutrition Survey (CHNS), comprising 39,672 individuals and 180,696 person-year observations. Growth-curve models were used to estimate trajectories of self-rated health and assess the interactive effects of social class, physical activity, and age, controlling for demographic characteristics. Results Health inequalities exhibited structural rigidity: health gradients between social strata widened from 1997 to 2015, and early-life disparities persisted throughout aging, forming “parallel trajectories.” Physical activity effects differed significantly by class. Lower-stratum individuals benefited little due to structural constraints; middle-stratum participants showed a “health-behavior paradox,” where participation correlated with steeper health decline; upper-stratum groups demonstrated negligible marginal gains due to resource saturation. Conclusion Universal sports-promotion strategies are insufficient to reduce entrenched health inequalities. Structural reforms addressing socioeconomic constraints, combined with class-sensitive behavioral interventions, are essential to disrupt the reproduction of health disparities and promote equitable healthy aging across the life course.
Yu et al. (2026) conducted a cohort in Health inequalities (n=39,672). Adolescent sports participation vs. Non-participation was evaluated on Self-rated health trajectory (social class × sports participation × age interaction) (β -0.0409, p=<0.05). Adolescent sports participation failed to mitigate entrenched class-based health inequalities across the life course, as evidenced by a significant three-way interaction between social class, sports participation, and age (β -0.0409, p<0.05).