Cross national patterns in educational inequalities in functional limitations among middle aged and older adults at two time points.

Introduction: In recent decades, the global population has aged rapidly while socioeconomic inequalities in health have widened, with older adults who are most disadvantaged experiencing the poorest health. Functional limitations are key predictors of disability and quality of life and are therefore considered an important measure of how well individuals and populations are aging. We determine if educational inequalities in functioning have widened over time and across countries.

Methods: We used data from five nationally representative surveys of aging, covering 14 high- and middle-income countries, with harmonized measures of functional limitations. We examined change over time in the number of functional limitations among adults aged 50-64 and 65 and older in each country as well as changes in educational inequality in functional limitations over time for both age groups.

Results: In most high-income countries, the number of functional limitations decreased over time, but they increased in China and Mexico, with the largest increases occurring among adults 65 and older. Educational inequality in functional limitations among those aged 65 and older widened for several countries in our study, but for different reasons. In some countries, it widened due to increased limitations among the least-educated, while in others it widened due to declines in limitations among the most-educated.

Conclusion: Growing educational inequality in functional limitations for older adults in several high- and middle-income countries suggests that, despite improvements in health and mortality, socioeconomic differences in functional health among older adults are widening.