Education as A Moderator in the Effect of Successful Aging on Mortality Risk in Different Genders of Elderly Chinese: a National Longitudinal Study (2011-2016)

Abstract Background Plenty of evidence has found that successful aging and its components were significantly associated with older adults’ health, their achievement has a positive effect on reducing mortality rates. However, it is unclear whether education could modify the effect of successful aging on morality risk. Numerous literatures from worldwide were cross-sectional and previous studies on the association between successful aging and mortality in China were quite few. Methods Using four waves (2011-2012, 2013-2014, 2014-2015, 2015-2016) of a large nationally representative survey in China derived from CHARLS (China Health and Retirement Longitudinal Study) with 4,824 older adults aged 60 and older, this study aimed to evaluate the effect of successful aging and each of its components on mortality risk of different gender of older adults in China, we further discussed whether education was a moderator in this effect and investigated differences in results among males and females. Successful aging was measured by absence of major diseases, freedom from disability, high cognitive function, no depressive symptoms, and active social engagement in life. Cox proportional hazards models were applied to estimate the education's moderate effect on the relationship between successful aging and mortality after controlling a rich set of covariates that included demographics, socioeconomic status, and health behaviors. Results We found that 15.18% (n=367) for males and 15.74% (n=379) for females were defined as successful aging and the mortality were 2.61% (n=63) for males and 3.45% (n=83) for females during the survey. The overall prevalence of successful aging in both genders were12.5% (n=603) and the overall mortality rate was 3.03% (n=146).It is the first longitudinal study using national cohort data to research the educational effects on the association between mortality and successful aging, our study showed that the effect only existed in females aged 65-74 years old group with lower education. Conclusions Education has the significant effect on the relationship between successful aging and mortality. Physical health is significantly associated with the achieving of successful aging among young older. More measures should be paid on improving mental health among the young female older with lower education to achieve successful aging and to against mortality and live longevity.