Changing educational attainment as a driver of cohort changes in healthy longevity: a decomposition analysis of US birth cohorts

An anticipated health boost from the increasing educational attainment of the US population has not materialized, with life expectancy and healthy longevity both stagnating over the past decade. We seek to understand how changes in the level of educational attainment across successive birth cohorts in the US have impacted disability-free life expectancy (DFLE) among older Americans. We analyzed data from the US Health and Retirement Study spanning 2000 to 2020, focusing on four ten-year birth cohorts. We then decomposed changes in population-level expectancies into contributions from shifts in educational composition, health status at midlife, and health and mortality transitions at older ages across different educational groups. DFLE increased notably for females but not for males, with disabled life expectancy (DLE) remaining stable. Shifts in educational composition primarily drove increases in DFLE and total life expectancy. However, deteriorating midlife health among those without a high school diploma reduced DFLE for this group, which tempered overall population-level gains. Health and mortality transitions among the less educated contributed to increased DLE. Our findings show that educational attainment is a major structural factor influencing US population health. Expanding access to higher education and reducing education inequality will play a significant role in future changes to healthy longevity.