ent across the lifespan (Taylor, 2010) (Figure 4-1). In addition to leading to higher income and professional status, thus providing greater access to health care, health insurance, and technological and personnel assistance, there are a number of other pathways by which education might influence the onset or course of disability, including enhancement of psychosocial resources, lifestyle differences (smoking, exercise), presence of fewer stressors such as marital or legal problems, and occupational factors—for example, more-educated individuals are less likely to be exposed to the risks of injury common in agricultural, commercial fishing, and construction work.
Since the beginning of the twentieth century there has been a very significant increase in educational attainment in the United States in successive cohorts of elderly (Figure 4-2). This secular change in education has been an important driver of changes in disability.
Poverty poses special risks as it is associated with significant increases in many biological risk factors for ill health and disability, especially during midlife. Poverty is related to not only the onset but also the course of disability, leading to the widely accepted view that the poor may age as much as a decade sooner than those who are well off (Crimmins, Kim, and Seeman, 2009; Taylor, 2010) (Figure 4-3). Regardless of the specific pathways operational in a given individual or group, it is abundantly clear that well-educated, high-income individuals are at greater advantage regarding survival and functional capacity while relatively uneducated, poor individuals are at greater relative risk.
FIGURE 4-1 Age, education, and functional decline, 2002–2004. SOURCE: MacArthur Foundation Research Network on an Aging Society (2009), based on data from the National Health Interview Survey.