Life satisfaction through an intersectional lens: insights from the BELHEALTH cohort

Abstract Background Life satisfaction (LS) is a key indicator of positive mental health and general wellbeing. While its individual predictors are well-documented, less is known about how multiple social categories interplay to shape inequalities. This study applies an intersectional perspective to examine how age, sex and subjective social status (SSS) jointly influence LS. Methods Data were drawn from the March 2025 wave of BELHEALTH, a cohort study of the Belgian population (18+, N = 6,122). LS was self-rated on a scale from 0 to 10. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to assess intersectional inequalities across 24 strata defined by the combination of sex (male/female), SSS (low/middle/high, based on the MacArthur scale) and age group (18-29, 30-49, 50-64, 65+). Results Inequality between strata explained 19.6% of the total variance in LS. Most of this variance (95.9%) was attributable to additive effects of sex, SSS and age. A difference of over two points separated the highest-scoring group (males, high SSS, 65+: predicted LS score = 8.26) from the lowest (males, low SSS, age 50-64: 6.02). Among individuals with low SSS, males reported lower LS than females, especially among the 50-64 age group (6.02; 95% CI: 5.86-6.19 vs. 6.34; 95% CI: 6.22-6.46). LS was highest among older adults (65+) across all SSS levels. Older adults with middle SSS (7.65-7.66) even reported LS levels comparable to younger people with high SSS (7.50-7.80). Conclusions The MAIHDA approach revealed large heterogeneity in LS, particularly within the low SSS group, where middle-aged men (50-64) scored lower than women. No sex differences were observed within the middle and high SSS groups. These findings demonstrate the value of intersectional analysis in uncovering inequalities that may be missed when examining social categories separately. Future research should explore potential gendered patterns in how men and women self-report life satisfaction. Key messages • Life satisfaction was lowest among middle-aged men with low subjective social status. Older adults (65+) reported higher scores than their younger counterparts across all social status levels. • Intersectional analysis reveals disparities in life satisfaction that would be overlooked using traditional approaches.