Department of Sociology and Gerontology, Miami University, 375 Upham Hall, Oxford, OH 45056, USA.
Department of Statistics, Miami University, 311 Upham Hall, Oxford, OH 45056, USA.
Maturitas. 2020 Apr;134:21-28. doi: 10.1016/j.maturitas.2020.01.002. Epub 2020 Jan 7.
To advance knowledge of the influence of educational level on trajectories and determinants of healthy ageing in midlife and older Americans.
Data are from the Health and Retirement Study, a nationally representative, longitudinal survey of Americans age 51 and over. We used generalized estimating equations to examine trajectories and determinants of healthy ageing by level of education among 17,591 adults followed over a 14-year period. Educational level was categorized as less than a high school diploma, high school diploma, some college education, and a college or higher degree. Potential determinants included demographic factors, early-life characteristics (childhood health and childhood poverty), health-related factors (health behaviours, physical and mental health conditions), and psychosocial characteristics (perceived neighbourhood safety, volunteerism, and work status).
Informed by earlier work, we defined healthy ageing as freedom from cognitive impairment, freedom from disability, and high physical functioning.
The log odds of healthy ageing declined over time in all educational groups. Importantly, the decline was smaller in adults with a college or higher degree than in those without a high school diploma. Age, gender, wealth, health behaviours, productive engagement, depressive symptoms, and the presence of chronic conditions predicted healthy ageing across the educational spectrum; however, the impact of several factors (age, gender, race/ethnicity, childhood poverty, and volunteerism) varied by educational level.
Education shapes trajectories of healthy ageing in the United States. Similarities and differences in determinants of healthy ageing are evident across levels of education. Findings highlight broad-based and education-specific targets for intervention.
增进对教育水平对美国中年和老年人健康老龄化轨迹和决定因素的影响的认识。
数据来自健康与退休研究，这是一项针对 51 岁及以上美国人的全国代表性、纵向调查。我们使用广义估计方程，在 17591 名成年人中，根据教育程度，研究了 14 年期间健康老龄化的轨迹和决定因素。教育程度分为高中以下文凭、高中文凭、一些大学教育和大学或更高学位。潜在的决定因素包括人口统计学因素、早期生活特征（儿童健康和儿童贫困）、与健康相关的因素（健康行为、身体和心理健康状况）以及心理社会特征（感知邻里安全、志愿服务和工作状况）。
根据早期的研究，我们将健康老龄化定义为没有认知障碍、没有残疾和身体功能高。
所有教育群体的健康老龄化的对数几率随着时间的推移而下降。重要的是，具有大学或更高学位的成年人的下降幅度小于没有高中文凭的成年人。年龄、性别、财富、健康行为、生产性参与、抑郁症状和慢性疾病在整个教育范围内预测了健康老龄化；然而，一些因素（年龄、性别、种族/民族、儿童贫困和志愿服务）的影响因教育程度而异。
教育塑造了美国健康老龄化的轨迹。在不同的教育程度上，健康老龄化的决定因素既有相似之处，也有不同之处。研究结果突出了广泛的和针对教育的干预目标。
