title: Joint effect of education and main lifetime occupation on late life health: a cross-sectional study of older adults in Xiamen, China.
abstract: BACKGROUND
  The effects of education and occupation on health have been well documented individually, but little is known about their joint effect, especially their cumulative joint effect on late life health.
  
  
  METHODS
  We enrolled 14,292 participants aged 60+ years by multistage sampling across 173 communities in Xiamen, China, in 2013. Heath status was assessed by the ability to perform six basic activities of daily life. Education was classified in four categories: 'Illiterate', 'Primary', 'Junior high school' and 'Senior high school and beyond'. Main lifetime occupation was also four categorized: 'Employed', 'Farmer', 'Jobless' and 'Others'. Odds ratios (ORs) were estimated by random-intercept multilevel models regressing health status on education and main lifetime occupation with or without their interactions, adjusting by some covariates.
  
  
  RESULTS
  Totally, 13,880 participants had complete data, of whom 12.5% suffered from disability, and 'Illiterate' and 'Farmer' took up the greatest proportion (33.01% and 42.72%, respectively). Participants who were higher educated had better health status (ORs = 0.62, 0.46, and 0.44 for the 'Primary', 'Junior high school', and 'Senior high school and beyond', respectively, in comparison with 'Illiterate'). Those who were long term jobless in early life had poorest heath (ORs = 1.88, 95% CI 1.47 to 2.40). Unexpectedly, for the farmers, the risk of poor health gradually increased in relation to higher education level (ORs = 1.26, 1.28, 1.40 and 2.24, respectively). For the 'Employed', similar ORs were obtained for the 'Junior high school' and 'Senior high school and beyond' educated (both ORs = 1.01). For the 'Farmer' and 'Jobless', participants who were 'Illiterate' and 'Primary' educated also showed similar ORs.
  
  
  CONCLUSIONS
  Both education and main lifetime occupation were associated with late life health. Higher education was observed to be associated with better health, but such educational advantage was mediated by main lifetime occupation.
authors.affiliation: State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China.
authors.forename: Manqiong
authors.initials: M
authors.lastname: Yuan
authors.affiliation: State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Public Health, Tzu Chi University, 701, Sec. 3, Zhongyang Rd, Hualien City, Hualien County, Taiwan.
authors.forename: Cheng-I
authors.initials: CI
authors.lastname: Chu
authors.affiliation: State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China.
authors.forename: Ya
authors.initials: Y
authors.lastname: Fang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations; D016017:Odds Ratio; D012044:Regression Analysis; D012959:Socioeconomic Factors