The central theme of this application is the effect of education on health at older ages, specifically
multimorbidity and its association with disability. Differences in morbidity and mortality as a function of
education constitute one of the most consistent findings of epidemiologic research. The effects of education
extend into old age as evident in inequalities in functional impairment, disability, and life expectancy.
Recent data suggest that ongoing increases in life expectancy are accompanied by widening of educational
differences in life expectancy and disability. We identify multiple chronic conditions due to aging of
populations and poor understanding of their impact on functioning trajectories and disability as critical to
understanding the effects of education on health at older ages. The cross-sectional nature of much of the
research on multimorbidity and disability does not allow identification of prevention targets that could be
used to close the gap in health stats of older adults.
The overall aim of this application is to examine the effects of education on health at older ages using a
longitudinal study design, with a follow-up spanning the entire adult lifecourse. Our proposal is based on
the Whitehall II study which has pioneered research on health inequalities. The specific focus of the current
proposal is multimorbidity, with chronic diseases assessed using gold standard measures and its impact on
functioning trajectories, using both measured and reported functioning. A range of psychosocial,
behavioral, and biological pathways will be examined. An advantage of our study is comprehensive data on
socioeconomic trajectory subsequent to education, allowing estimation of effects of education independent
of this pathway. Non-response in the study is low and linkage to electronic health records for all
participants, irrespective of their continued participation is a further advantage. We propose to examine
education based inequalities in multimorbidity and underlying mechanisms (AIM 1), assess the associations
and mechanisms that explain education related differences in measured and reported functioning
trajectories and disability over the adult lifecourse (AIM 2), and examine whether education buffers the
effect of multimorbidity on disability at older ages and identify underlying mechanisms (AIM 3). Our
overarching hypothesis is that multimorbidity and suboptimal control of risk factors explain the greater
burden of disability in lower education groups.
Health promotion can ensure that older people with chronic conditions and disabilities remain active and
independent, preventing institutionalization and declining health. The improvements in life expectancy and
disability rates in the high education groups suggests that it is possible to extend these all population
groups to ensure that most older people remain healthy, active, and independent for as long as possible. In
order to do this, a better understanding of the pathways through which education affects health at older
ages is needed; evidence that this proposal aims to generate.