Mechanistic pathways between adult child education and late-life parental health outcomes: cross-national comparisons across the US, Mexico, and India.

A growing body of evidence across global contexts supports the notion that adult child education may have upward spillover effects on late-life parental health outcomes through heterogeneous mechanistic pathways. However, comparisons of these pathways across diverse study contexts are challenging given differences in exposure and outcome definitions, modeling strategies, and covariate adjustment strategies. We sought to improve cross-national comparisons by using harmonized data spanning 2015-2017 from the Health and Retirement Study (HRS, N = 11,584) in the US, the Mexican Health and Aging Study (MHAS, N = 9,599) in Mexico, and the Longitudinal Aging Study (LASI, N = 29,576) in India, along with harmonized modeling approaches. We estimated associations between years of adult child education and hypothesized mediators of late-life health outcomes (considered outcomes in the current study) across four domains (financial, intergenerational contact, psychosocial well-being, and health behaviors) using generalized linear models. There were large differences in the prevalence of hypothesized mediators across settings (e.g., prevalence of child-to-parent financial transfers: 5.3% in HRS, 46.9% in MHAS, 13.2% in LASI). We also observed some notable heterogeneity in associations between adult child education and hypothesized mediators (e.g., odds ratios for co-residence vs. not of 0.89 [95% CI 0.85-0.93] in HRS, 1.02 [0.96-1.06] in MHAS, or 1.04 [1.02-1.06] in LASI per year of education). However, there was consistency in the multifaceted nature of associations across domains that may in turn shape chronic disease risk, highlighting the potential wide-ranging effects of intergenerational gains in education. Results can help contextualize cross-country differences and may serve to motivate future mediation analyses.