title: Type of high-school credentials and older age ADL and IADL limitations: is the GED credential equivalent to a diploma?
abstract: OBJECTIVE
  Educational attainment is a robust predictor of disability in elderly Americans: older adults with high-school (HS) diplomas have substantially lower disability than individuals who did not complete HS. General Educational Development (GED) diplomas now comprise almost 20% of new HS credentials issued annually in the United States but it is unknown whether the apparent health advantages of HS diplomas extend to GED credentials. This study examines whether adults older than 50 years with GEDs have higher odds of incident instrumental or basic activities of daily living (IADLs) limitations compared with HS degree holders.
  
  
  METHODS
  We compared odds of incident IADL limitations by HS credential type using discrete-time survival models among 9,426 Health and Retirement Study participants followed from 1998 through 2008.
  
  
  RESULTS
  HS degree holders had lower odds of incident IADLs than GED holders (OR = 0.72, 95% CI = 0.58, 0.90 and OR = 0.69, 95% CI = 0.56, 0.86 for ADLs and IADLs, respectively). There was no significant difference in odds of incident IADL limitations between GED holders and respondents without HS credentials (OR = 0.89, 95% CI = 0.71, 1.11 for ADLs; OR = 0.88, 95% CI = 0.70, 1.12 for IADLs).
  
  
  CONCLUSIONS
  Although GEDs are widely accepted as equivalent to high school diplomas, they are not associated with comparable health advantages for physical limitations in older age.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, 401 Park Drive, Room 28E , Boston, MA 02215, USA. szeliu@hsph.harvard.edu
authors.forename: Sze Yan
authors.initials: SY
authors.lastname: Liu
authors.forename: Niraj R
authors.initials: NR
authors.lastname: Chavan
authors.forename: M Maria
authors.initials: MM
authors.lastname: Glymour
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D006233:Persons with Disabilities / Q000193:education* / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D012959:Socioeconomic Factors; D014481:United States