Educational Inequalities in Dual-Function Life Expectancy.

OBJECTIVES: This study investigates educational inequalities in dual functionality, a new concept that captures a combination of physical and cognitive functioning, both of which are important for independent living and quality of life.

METHODS: Using data from the Health and Retirement Study and the National Health Interview Study Linked Mortality Files, we define a measure of dual functionality based on the absence of limitations in activities of daily living and dementia. We estimate age-graded dual-function rates among adults 65+ and age-65 dual-function life expectancy across levels of education stratified by gender.

RESULTS: In their mid 60s, 67 percent of women with less than a high school degree manifest dual functionality as compared with over 90 percent of women with at least a four-year college degree. A similar pattern holds among men. These education-based gaps in dual functionality remain across later life, even as dual-function rates decline at older ages. Lower dual-function rates among older adults with less education translate into inequalities of 6.7 and 7.3 years in age-65 dual-function life expectancy between men and women respectively with at least a four-year college degree compared to their counterparts with less than a high school degree.

DISCUSSION: Older adults, particularly women, with less than a high school degree are estimated to live a smaller percentage of their remaining years with dual functionality compared with older adults with at least a college degree. These inequalities have implications for the distribution of caregiving resources of individuals, family members, and the broader health care community.