Educational attainment and activities of daily living limitations among older U.S. adults: attenuation after adjustment for health-related indicators in the 2022 Health and Retirement Study

Background
Activities of daily living (ADL) limitations are important indicators of functional independence in older adults. This study examined the association between educational attainment and ADL limitations among older U.S. adults and assessed whether this association was attenuated after adjustment for health-related indicators.

Methods
We conducted a cross-sectional analysis using the 2022 Health and Retirement Study and RAND HRS data products. Adults aged 50 years and older with complete data on education, ADL limitations, demographic characteristics, and health-related variables were included. Any ADL limitation was defined as difficulty in at least one of six basic activities. Logistic regression models were fitted sequentially, adjusting for demographic characteristics, chronic disease burden, self-rated health, and depressive symptoms. Respondent-level weights were applied in weighted analyses.

Results
Among 11,695 participants, 2,153 reported at least one ADL limitation. Lower educational attainment was associated with higher odds of ADL limitation. In weighted models, each additional year of education was associated with lower odds of ADL limitation in the demographic-adjusted model. This association was attenuated after further adjustment for chronic disease burden, self-rated health, and depressive symptoms, with the largest attenuation observed after inclusion of self-rated health. Similar patterns were observed in sensitivity analyses using categorized education and ADL count.

Conclusions
Lower educational attainment was associated with higher odds of ADL limitations among older U.S. adults. Adjustment for health-related indicators, particularly self-rated health, substantially attenuated this association. These findings suggest that health-related differences may be linked to educational disparities in late-life functional limitations, although causal interpretation is limited by the cross-sectional design.