School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, 100191, Beijing, People's Republic of China.
School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Street, Haidian District, 100872, Beijing, People's Republic of China.
BMC Geriatr. 2018 Apr 11;18(1):89. doi: 10.1186/s12877-018-0785-4.
Despite decades of study, debates exist surrounding the relationship between education and functional health status transition among elderly populations. This study aims to add evidence to the debates using China as a case study. Specifically, this study analysed the association of education with functional health status transition and then the mechanism behind that association using the budget constraint relax hypothesis and the efficiency improvement hypothesis among elderly population in China.
Based on data from the Chinese Longitudinal Healthy Longevity Surveys from 2008 and 2011, this study focussed on adults aged 65 years and above, with a final sample size of 12,112. A generalised structural equation model was used to analyse the relationship between education and functional health status transition and the mechanism behind that association.
During the three examined years, among elderly adults who were nondisabled at baseline, 53.1% stayed nondisabled, 14.6% became disabled, and 32.3% died; among those disabled in 2008, 8.1% recovered, 21.6% stayed disabled, and 70.3% died. Compared with older adults without any education, those who had attended primary schools had both lower mortality and disability, whereas those who had attended high schools and above only had a lower mortality rate. The budget constraint relax hypothesis and the efficiency improvement hypothesis explained the majority of the relationship between education and transition from non-disability to death, but hardly explained the transition from non-disability to disability. Furthermore, once a person was disabled, education had no significant relationship with functional ability recovery or mortality.
Attending primary school seems to provide the highest benefit to functional health status transition among older and nondisabled persons in China. Those who attended high schools and above are expected to live a longer life with disability. The mechanism between education and the onset of disability needs more discussion.
尽管经过几十年的研究，关于教育与老年人群体功能健康状况转变之间的关系仍存在争议。本研究旨在通过以中国为例来为这些争议提供证据。具体来说，本研究通过预算约束放松假说和效率提高假说分析了教育与中国老年人口功能健康状况转变之间的关系及其背后的机制。
本研究基于 2008 年和 2011 年中国纵向健康长寿调查的数据，重点关注年龄在 65 岁及以上的成年人，最终样本量为 12112 人。使用广义结构方程模型分析了教育与功能健康状况转变之间的关系及其背后的机制。
在三年内，在基线时无残疾的老年人群中，53.1%保持无残疾，14.6%变为残疾，32.3%死亡；在 2008 年残疾的人群中，8.1%康复，21.6%保持残疾，70.3%死亡。与未接受过任何教育的老年人相比，接受过小学教育的老年人死亡率和残疾率均较低，而接受过中学及以上教育的老年人死亡率较低。预算约束放松假说和效率提高假说解释了教育与从不残疾到死亡的转变之间的大部分关系，但几乎无法解释从不残疾到残疾的转变。此外，一旦一个人残疾，教育与功能能力恢复或死亡率之间没有显著关系。
在中国，接受小学教育似乎对老年且无残疾人群的功能健康状况转变最有益。那些接受过中学及以上教育的人可能会在残疾状态下活得更长。教育与残疾发生之间的机制需要进一步讨论。
