OBJECTIVES To advance knowledge of the influence of educational level on trajectories and determinants of healthy ageing in midlife and older Americans. STUDY DESIGN Data are from the Health and Retirement Study, a nationally representative, longitudinal survey of Americans age 51 and over. We used generalized estimating equations to examine trajectories and determinants of healthy ageing by level of education among 17,591 adults followed over a 14-year period. Educational level was categorized as less than a high school diploma, high school diploma, some college education, and a college or higher degree. Potential determinants included demographic factors, early-life characteristics (childhood health and childhood poverty), health-related factors (health behaviours, physical and mental health conditions), and psychosocial characteristics (perceived neighbourhood safety, volunteerism, and work status). MAIN OUTCOME MEASURES Informed by earlier work, we defined healthy ageing as freedom from cognitive impairment, freedom from disability, and high physical functioning. RESULTS The log odds of healthy ageing declined over time in all educational groups. Importantly, the decline was smaller in adults with a college or higher degree than in those without a high school diploma. Age, gender, wealth, health behaviours, productive engagement, depressive symptoms, and the presence of chronic conditions predicted healthy ageing across the educational spectrum; however, the impact of several factors (age, gender, race/ethnicity, childhood poverty, and volunteerism) varied by educational level. CONCLUSIONS Education shapes trajectories of healthy ageing in the United States. Similarities and differences in determinants of healthy ageing are evident across levels of education. Findings highlight broad-based and education-specific targets for intervention.

中文翻译：

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中年和老年美国人健康老龄化轨迹和决定因素的教育差异

目标 提高对教育水平对中年和老年美国人健康老龄化轨迹和决定因素影响的认识。研究设计数据来自健康与退休研究，这是一项针对 51 岁及以上美国人的全国代表性纵向调查。我们使用广义估计方程来检查在 14 年期间跟踪的 17,591 名成年人中不同教育水平的健康老龄化的轨迹和决定因素。教育水平被归类为低于高中文凭、高中文凭、某些大学教育和大学或更高学位。潜在的决定因素包括人口因素、早期生活特征（儿童健康和儿童贫困）、健康相关因素（健康行为、身心健康状况）、和社会心理特征（感知邻里安全、志愿服务和工作状态）。主要结局指标 根据早期工作，我们将健康老龄化定义为无认知障碍、无残疾和高身体机能。结果 在所有教育群体中，健康老龄化的对数几率随着时间的推移而下降。重要的是，与没有高中文凭的成年人相比，拥有大学或更高学位的成年人的下降幅度较小。年龄、性别、财富、健康行为、生产性参与、抑郁症状和慢性病的存在预测了整个教育范围内的健康老龄化；然而，若干因素（年龄、性别、种族/民族、儿童贫困和志愿服务）的影响因教育水平而异。结论 教育塑造了美国健康老龄化的轨迹。不同教育水平的健康老龄化决定因素的异同是显而易见的。调查结果强调了干预的广泛基础和教育特定目标。