Educational attainment and male-female health-survival paradox among older adults in China: a nationally representative longitudinal study.

Abstract

Background: The male-female health-survival paradox is characterized by the phenomenon where "women get sicker, but men die quicker." Health expectancy, as a composite metric that encompasses both the quantity and quality of life, serves as a unique tool for analyzing this gender paradox. In this study, we investigate the relationship between educational attainment and the gender paradox among older adults in China.

Methods: Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), we focused on community-dwelling individuals aged 60 and above. Health was assessed using the Activities of Daily Living (ADLs). Educational attainment was dichotomized into low (primary education and below) and high (secondary education and above). We controlled for demographic, socioeconomic, and health behaviors confounders. Microsimulation techniques were employed to estimate total life expectancy (TLE), disability-free life expectancy (DFLE), and health ratio.

Results: In China, educational attainment was positively associated with TLE and DFLE, with these benefits being more pronounced in females. Among individuals with lower educational attainment, females had significantly greater TLE (female-male difference: 3.82 years, 95% CI: 3.68 to 3.96) and DFLE (2.91 years, 95% CI: 2.78 to 3.04), but a lower health ratio (-2.14%, 95% CI: -2.41% to -1.87%) compared to males. In contrast, females with higher educational attainment not only lived longer but also healthier. Among these individuals, females had significantly greater TLE (5.89 years, 95% CI: 5.71 to 6.08), DFLE (6.02 years, 95% CI: 5.84 to 6.19), and a more favorable health ratio (95% CI: 2.60% to 3.19%) compared to males.

Conclusions: Education plays a crucial role in enabling females to overcome disadvantages associated with the gender paradox in China. Enhancing gender equality in educational opportunities is expected to promote healthy longevity among females in the country.