Educational attainment, health status, and functional limitations among older U.S. adults: evidence from the 2022 Health and Retirement Study

Objective: To examine whether educational attainment is associated with activities of daily living (ADL)
limitation among U.S. adults aged ≥50 years after accounting for health status.
Methods: We conducted a cross-sectional analysis using data from a nationally representative survey,
the 2022 Health and Retirement Study. The analytic sample included 1,695 participants (complete-case
analysis). ADL limitation was defined as difficulty in ≥1 of dressing, walking across a room, bathing, or
using the toilet. Education was measured as years completed. Logistic regression estimated odds ratios
(ORs) and 95% confidence intervals (CIs) adjusting for sex, hypertension, and self-rated health, with sexstratified and rescaled-education sensitivity analyses.
Results: ADL limitation was reported by 857/1,695 (50.6%) participants. Those with ADL limitation had
fewer years of education (12.61 vs 13.89; p < 0.001). Higher education was associated with lower odds
of ADL limitation, but the association was attenuated after adjustment for self-rated health (fully
adjusted OR per 1-year = 0.961, 95% CI: 0.928–0.996; per 5-year = 0.822, 95% CI: 0.690–0.978). Poorer
self-rated health (OR = 2.379 per category, 95% CI: 2.102–2.692) and hypertension (OR = 1.364, 95% CI:
1.099–1.694) were strongly associated with higher odds of ADL limitation.
Conclusion: Educational attainment was modestly associated with lower odds of ADL limitation, and the
association was substantially attenuated after accounting for self-rated health, suggesting that
differences in health status may partly explain the observed education–ADL gradient. Targeting chronic
disease management and incorporating scalable health measures may support prevention of functional
decline, with education serving as a marker of social vulnerability.