Perceived health inequalities in OECD countries: A macro-level cluster analysis

Although perceived health inequalities remain a persistent problem across the OECD, the interaction of socioeconomic factors with sex and their structural differences have not yet been sufficiently investigated. Existing one-dimensional analyses are inadequate in explaining the complex nature of these inequalities at the macro level. This study examines perceived health inequalities in terms of socioeconomic status and sex and develops a novel typology that groups countries according to their inequality profiles. The analysis uses aggregated data from 39 countries covering the period 2003–2024. Linear Mixed Effects Models were used for regression analyses, and the K-means clustering algorithm was used to construct the country typology. The results show that at the macro level, higher income is strongly associated with better perceived health (β = 20.60, p < 0.001). Remarkably, the positive relationship between education and health is significantly stronger in females compared to males. The negative interaction coefficient obtained (βinteraction = −10.79, p < 0.001) indicates that the sex-based health gap narrows at higher education levels. Cluster analysis identified two distinct groups of countries: “High Inequality Profile” and “Low Inequality Profile”. These findings highlight the potential “equalizing” role of education and reveal that health inequalities are not homogeneous. Consequently, policy interventions should target disadvantaged groups intersectionally and be designed according to the specific structural characteristics of each country.