Educational attainment, health status, and functional limitations among older U.S. adults: evidence from the 2022 Health and Retirement Study

Objective: To examine whether educational attainment is associated with activities of daily living (ADL) limitation among U.S. adults aged ≥50 years after accounting for health status. Methods: We conducted a cross-sectional analysis using data from a nationally representative survey, the 2022 Health and Retirement Study. The analytic sample included 1,695 participants (complete-case analysis). ADL limitation was defined as difficulty in ≥1 of dressing, walking across a room, bathing, or using the toilet. Education was measured as years completed. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) adjusting for sex, hypertension, and self-rated health, with sex-stratified and rescaled-education sensitivity analyses. Results: ADL limitation was reported by 857/1,695 (50.6%) participants. Those with ADL limitation had fewer years of education (12.61 vs 13.89; p < 0.001). Higher education was associated with lower odds of ADL limitation, but the association was attenuated after adjustment for self-rated health (fully adjusted OR per 1-year = 0.961, 95% CI: 0.928–0.996; per 5-year = 0.822, 95% CI: 0.690–0.978). Poorer self-rated health (OR = 2.379 per category, 95% CI: 2.102–2.692) and hypertension (OR = 1.364, 95% CI: 1.099–1.694) were strongly associated with higher odds of ADL limitation. Conclusion: Educational attainment was modestly associated with lower odds of ADL limitation, and the association was substantially attenuated after accounting for self-rated health, suggesting that differences in health status may partly explain the observed education–ADL gradient. Targeting chronic disease management and incorporating scalable health measures may support prevention of functional decline, with education serving as a marker of social vulnerability.