BackgroundDespite the importance of midlife with reference to one’s health, educational inequalities in midlife health have attracted little attention in China. Using Cox proportional hazards regression analysis, this study examined the association between educational attainment and the onset of midlife health problems and investigated the potential mediating effects of socioeconomic position (SEP) other than educational attainment, depression, and health behavior.MethodsData were extracted from the China Health and Retirement Longitudinal Survey (CHALRS) from 2011 (baseline) to 2018 (latest data). Participants aged 45–59 years at baseline were studied (N = 8,050). Health outcomes included the onset of poor self-rated health (SRH), limitation in activities of daily living (ADL) and instrumental ADL (IADL), multimorbidity, hypertension, dyslipidemia, heart diseases, and stroke over the 7-year follow-up period. Cox proportional hazard models were used to examine the associations of the outcomes with educational attainment, while controlling for potential mediators (other SEP, depression, and health behaviors).ResultsLower educational level was associated with increased incidences of poor SRH and ADL/IADL limitations, but with decreased incidences of dyslipidemia and heart disease. After adjusting for baseline covariates, the RII was 2.17 (95% confidence interval [CI]: 1.74, 2.70) for poor SRH, 2.15 (95% CI: 1.42, 3.26) for ADL limitation, 3.84 (95% CI: 2.98, 4.94) for IADL limitation, 0.52 (95% CI: 0.40, 0.68) for dyslipidemia, and 0.55 (95% CI: 0.40, 0.74) for heart disease. Significant proportions (2.1 to 27.0%) of the RII were explained by the mediators. No sex or urban–rural differences were found in this study.ConclusionOur findings suggest that educational attainment is an important predictor of the incidences of key midlife health problems, with significant mediating effects exerted by other indicators of SEP, depression, and health behavior.

Background: Despite the importance of midlife with reference to one’s health, educational inequalities in midlife health have attracted little attention in China. Using Cox proportional hazards regression analysis, this study examined this issue and investigated the potential mediating effects of socioeconomic position (SEP) other than educational attainment, stress level, and health behavior. Methods: Data were extracted from the China Health and Retirement Longitudinal Survey (CHALRS) from 2011 (baseline) to 2018 (latest data). Participants aged 45-59 years at baseline were studied (N = 8050). Health outcomes included the onset of poor self-rated health (SRH), limitation in activities of daily living (ADL) and instrumental ADL (IADL), multimorbidity, hypertension, dyslipidemia, heart diseases, and stroke over the 7-year follow-up period. Cox proportional hazard models were used to examine the associations of the outcomes with educational attainment, while controlling for potential mediators (other SEP, stress level, and health behaviors). The relative index of inequality (RII) was used to measure educational inequality.Results: Lower educational level was associated with increased incidences of poor SRH and ADL/IADL limitations, but with decreased incidences of dyslipidemia and heart disease. After adjusting for baseline covariates, the RII was 2.02 (95% confidence interval [CI]: 1.61, 2.53) for poor SRH, 2.16 (95% CI: 1.41, 3.29) for ADL limitation, 3.55 (95% CI: 2.73, 4.51) for IADL limitation, 0.54 (95% CI: 0.41, 0.71) for dyslipidemia, and 0.57 (95% CI: 0.42, 0.72) for heart disease. Minimal to moderate proportions (0.0 to 31.0%) of the RII were explained by the mediators. No sex or urban-rural differences were found in this study.Conclusion: Our findings suggest that educational attainment is an important predictor of the incidences of key midlife health problems, with limited mediating effects exerted by other indicators of SEP, stress, and health behavior.

The COVID-19 pandemic significantly impacted public health and quality of life, leading to government recommendations for vaccination. Using cross-sectional data from a nationwide population-based survey conducted in China (N = 6860), this study aimed to examine the associations between individual vaccine uptake and general trust in others, trust in government, and interaction with neighbors. We conducted a multilevel logistic regression analysis to examine the relevance of these factors at the individual and community levels. Among young adults, higher levels of general trust at both levels were positively associated with vaccination, with odds ratios (OR) of 1.35 (95% confidence interval [CI]: 1.07, 1.70) and 1.58 (95% CI: 1.14, 2.18), respectively. We also found a positive association between vaccination and community-level interaction with neighbors, with ORs of 1.55 (95% CI: 1.11, 2.17). In contrast, among older individuals, vaccination was positively associated only with individual-level interaction with neighbors, with an OR of 1.55 (95% CI: 1.15, 2.08). The results indicated that vaccine uptake was associated with an individual’s views of society and the social environment of the community, with substantial variations between the young and the old. Our findings emphasize the significance of public health measures to strengthen neighborhood interactions among older adults.