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Background  Little is known about the consequences of health comparisons. Negative health comparisons might, for example, result in emotions such as anger or frustration. These negative emotions might intensify feelings of social exclusion. Thus, the objective of the current study was to investigate whether health comparisons are associated with social exclusion. Moreover, it was examined whether the relation between health comparisons and social exclusion is moderated by self-efficacy.    Methods  We analyzed cross-sectional data of  N  = 7838 individuals from the German Ageing Survey. The German Ageing Survey is a representative sample of community-residing individuals aged 40 and over. An established social exclusion scale was used. The degree of self-efficacy was measured according to Schwarzer and Jerusalem. Health comparisons were measured with the question “How would you rate your health compared with other people your age” (Much better; somewhat better; the same; somewhat worse, much worse).    Results  Multiple linear regressions revealed that negative health comparisons were associated with feelings of social exclusion in men, but not women. Furthermore, positive health comparisons were weakly associated with decreased feelings of social exclusion in men. The association between negative as well as positive health comparisons and social exclusion in men was significantly moderated by self-efficacy.    Conclusions  The findings of the present study suggests that negative health comparisons are associated with feelings of social exclusion in men. In conclusion, comparison effects are not symmetric and predominantly upwards among men in the second half of life. Strengthening self-efficacy might be fruitful for attenuating this relationship.

Self-efficacy moderates the relationship between health comparisons and social exclusion: results of the German ageing survey