IJE Advance Access originally published online on January 25, 2007
International Journal of Epidemiology 2007 36(2):358-365; doi:10.1093/ije/dyl307
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Educational differences in the dynamics of disability incidence, recovery and mortality: Findings from the MRC Cognitive Function and Ageing Study (MRC CFAS)
1 Leicester Nuffield Research Unit, Department of Health Sciences, University of Leicester.
2 Epidemiology and Public Health Group, Peninsula Medical School, Exeter
3 MRC Biostatistics Unit, Cambridge.
4 Department of Public Health and Primary Care, University of Cambridge.
5 Medical Research Council Cognitive Function and Ageing Study http://www.cfas.ac.uk
* Corresponding author. Leicester Nuffield Research Unit, Department of Health Sciences, University of Leicester, 22–28 Princess Road West, Leicester LE1 6TP, UK. E-mail: cxj{at}le.ac.uk
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Abstract |
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Background This study aims to establish the extent of educational differences in the disability transitions of incidence, recovery and mortality in people aged 65 years and over, whether these can be explained by differentials in disease burden and their relative contribution to educational differences in prevalence and disability-free life expectancy (DFLE).
Methods A stratified random sample of 13 004 participants in five areas in England and Wales were interviewed in 1991–94 and followed up at 2, 6 (one centre only) and 10 years. Two levels of disability were analysed: mobility difficulty and activities of daily living (ADL) disability. We fitted logistic regression models to model educational differences in disability prevalence, incidence, recovery and mortality transitions. DFLE was calculated to assess the combined effect of the dynamic transitions.
Results Those with 
9 years education had higher ADL and mobility disability prevalence and higher incidence and lower recovery of mobility disability. Differences in disability incidence remained after adjustment for comorbidity. Women with the lowest education had shorter life expectancies (1.7 years less at the age of 65 years) than the most educated and had even shorter DFLE (1.9 years free of ADL disability and 2.8 years free of mobility difficulty at the age of 65 years).
Conclusions Differentials in education continue to contribute to prevalence of disability at ages beyond 65 years in both men and women and independently of diseases. These appear to be driven predominantly by differentials in disability incidence that also compound to produce greater differentials in DFLE between education groups than in total years lived.
Keywords MRC CFAS, socioeconomic factors, disability, old age, self-report, activities of daily living
Accepted 18 December 2006