Education and employment have a sex‐dependent effect on healthy aging in Mexico

Dear Editor,

Since the number of older people is rapidly growing worldwide, maintaining health and functioning in older individuals and identifying vulnerable aging groups is a priority.^{1, 2} Previous studies showed that women tend to live longer, but men tend to age healthier.^{3, 4} Biological factors, differences in lifestyle, illness, and socioeconomic factors can partially explain sex differences in health and disease.^{4, 5} However, it remains unclear whether being a woman is a modifier of the associations between biological factors, lifestyles, illnesses, socioeconomic status, and health outcomes. Therefore, we aimed to study the association of sex and socioeconomic variables with healthy aging in Mexico.

We used the information from the last two waves of the Mexican Health and Aging Study, a representative cohort of Mexican older adults, restricting our analysis to participants aged ≥60 at baseline. The Healthy Aging Score (HAS) for 2015 and 2018 was estimated as described by Sanchez‐Niubo et al. ⁶ We used 41 items related to biopsychosocial aspects of health and functioning to estimate each individual's score using the two‐parameter logistic item response theory model. ⁶ The variables included in the construction of the HAS were related to the intrinsic capacity and functional ability of the individual and included seven domains: cognition, psychology symptoms, vitality, sensory, mobility, activities of daily living, and instrumental activities of daily living. The estimated scores were converted to T‐scores with a mean of 50 and a standard deviation (SD) of 10. Information on sex, age, height, weight, education, income, net worth, physical activity, health conditions, and history of age‐related diseases was collected at baseline and follow‐up. Longitudinal random‐effect regression models were used to estimate the associations of sociodemographic and lifestyle variables with the HAS in 2015 and 2018. Interaction terms were included to evaluate whether being a woman may be an effect modifier of the obtained associations.

A total of 9851 participants were studied, 55.1% of which were women. Most variables exhibited significant sex‐specific differences: compared to men, women had a higher body mass index and higher prevalence of diabetes and were less physically active and more likely to be younger. Regarding socioeconomic variables, women tended to have a lower education level, income, and total net worth than men.

The average healthy aging score was 50.8 (SD = 9.4) in 2015 and 49.4 (SD = 10) in 2018. The average difference between the two waves was −1.43 HAS points (SD = 8.5), resulting in an estimated decline rate of 0.66% per year. Men scored higher than women, with a mean difference of 4.4 points in 2015 and 3.7 points in 2018. Participants who exercised, had a higher education, and were in the fourth quartile of income had higher scores (Fig. 1). Previous myocardial infarction, underweight, and overweight/obesity were negative associations. Interestingly, in women, the protective effect of schooling and employment was lower.

Figure 1.

Coefficients for the association of Healthy Aging Scores and related variables from the Mexican Healthy Aging Study 2015 and 2018. The graph displays the coefficients and 95% confidence intervals obtained from the random‐effect longitudinal regression model for the dependent variable of healthy aging. The model was also adjusted for age and wave indicator. Education categories: (1) no basic education (reference, <6 years of education); (2) completed basic education (6–9 years); (3) more than basic education (>9 years of education). Coefficients with 95% CI that do not overlap zero can be considered statistically significant. CI, confidence interval (line); Coef., coefficient (dot).

In the highest education group, the effect of education for men was β = 5.3 (95% CI, 4.6–6.0), and for women β = 4.1 (95% CI, 3.3–5.0) when including the interaction term. A similar trend was observed for employment; the protective effect in men was 3.0 (95% CI, 2.6–3.5), while the effect in women, including the interaction term, was β = 1.7 (95% CI, 1.2–2.2). No significant interactions were found between sex and income or net worth.

The strongest positive determinant of HAS was education, but the protective effect of higher education was smaller in women than in men. This finding could be related to the fact that women typically experience more complications during their education, and the intrinsic benefits of this training are not equivalent between sexes. ⁷ Employment was positively associated with healthy aging, but the effect was smaller in women. The wage gap between women and men in Mexico is the widest in Latin America, which suggests that they have to work harder to receive the same salaries as men. ⁸ Kaplan et al. ⁸ suggested that sex roles are still deeply rooted in the country, and a recent survey showed that even women who work more than 40 paid hours a week spend twice as many hours on unpaid work than men. ⁹

Our findings support the view that older men are more likely to achieve healthy aging since the protective effect of education and employment is lower in women than men. Our data suggest, for the first time, a sex‐specific effect of education and employment on healthy aging in older people living in a middle‐income country.

Disclosure statement

The authors declare no conflict of interest.

Arroyo‐Quiroz C, Brunauer R, Alavez S. Education and employment have a sex‐dependent effect on healthy aging in Mexico. Geriatr. Gerontol. Int. 2023;23:980–981. 10.1111/ggi.14731

Data availability statement

The data that support the findings of this study are available in Mexican Health and Ageing Study (MHAS) site at https://www.mhasweb.org/DataProducts/Home.aspx. These data were derived from the following resources available in the public domain: https://www.mhasweb.org/Documentation/Home.aspx