Educational differences in trajectories and determinants of healthy ageing in midlife and older Americans

•Americans with the least education have a markedly less favourable healthy ageing trajectory than those with the most.•Most determinants of healthy ageing are shared across the educational spectrum; however, educational variation is evident in the impact of some.•Americans would benefit from actions encouraging healthy body weight, physical and productive activity, and disease prevention/management.•Fostering volunteer opportunities may be especially effective in promoting healthy ageing in Americans with the least education. To advance knowledge of the influence of educational level on trajectories and determinants of healthy ageing in midlife and older Americans. Data are from the Health and Retirement Study, a nationally representative, longitudinal survey of Americans age 51 and over. We used generalized estimating equations to examine trajectories and determinants of healthy ageing by level of education among 17,591 adults followed over a 14-year period. Educational level was categorized as less than a high school diploma, high school diploma, some college education, and a college or higher degree. Potential determinants included demographic factors, early-life characteristics (childhood health and childhood poverty), health-related factors (health behaviours, physical and mental health conditions), and psychosocial characteristics (perceived neighbourhood safety, volunteerism, and work status). Informed by earlier work, we defined healthy ageing as freedom from cognitive impairment, freedom from disability, and high physical functioning. The log odds of healthy ageing declined over time in all educational groups. Importantly, the decline was smaller in adults with a college or higher degree than in those without a high school diploma. Age, gender, wealth, health behaviours, productive engagement, depressive symptoms, and the presence of chronic conditions predicted healthy ageing across the educational spectrum; however, the impact of several factors (age, gender, race/ethnicity, childhood poverty, and volunteerism) varied by educational level. Education shapes trajectories of healthy ageing in the United States. Similarities and differences in determinants of healthy ageing are evident across levels of education. Findings highlight broad-based and education-specific targets for intervention.