Education and Successful Aging Among Chinese Elderly: Insights from CLASS Data

Education and Successful Aging Among Chinese Elderly: Insights from CLASS Data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Education and Successful Aging Among Chinese Elderly: Insights from CLASS Data He Gu, Qingli Tan, Yu Zhang, Han He This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6798552/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study uses data from the 2020 China Longitudinal Aging Social Survey (CLASS) to analyze the status of successful aging among Chinese elderly individuals and the impact of education on successful aging. It explores the characteristics of China's aging process and the effects of education, providing a basis for formulating appropriate aging policies. Methods: The study included 9,181 participants, with 5,730 (62.41%) elderly individuals with low education, 2,356 (25.66%) with medium education, and 1,095 (11.93%) with high education. Descriptive statistical analysis was first conducted to compare the demographic characteristics of elderly individuals with different education levels. The study then described the levels of successful aging and the status of the five measurement dimensions for each group, using χ² tests for differences. Subsequently, multi-factor logistic regression was employed to analyze the effects of education, controlling for demographic variables, health status and behavioral variables, and family, community, and policy variables. Finally, based on the previous analysis, heterogeneity analysis was performed to examine the impact of education on successful aging across different regions, genders, ages, and income levels. Results: The overall level of successful aging among the elderly was 15.15% (1,391/9,181). The successful aging levels for elderly individuals with low, medium, and high education were 11.06%, 20.20%, and 25.66%, respectively (P < 0.01). Elderly individuals with higher education levels performed better than those with lower education in terms of chronic diseases, functional loss, cognitive function, depression symptoms, and social activity participation (P < 0.01). Multi-factor logistic regression results showed that, after controlling for demographic variables, elderly individuals with medium and high education had successful aging levels 1.581 times (OR=1.581, 95% CI=1.299-1.924) and 2.086 times (OR=2.086, 95% CI=1.677-2.595) higher, respectively, than those with low education. After further controlling for health status and behavioral variables, elderly individuals with medium and high education had successful aging levels 1.480 times (OR=1.480, 95% CI=1.210-1.811) and 1.818 times (OR=1.818, 95% CI=1.450-2.281) higher, respectively. After controlling for family, community, and policy variables, elderly individuals with medium and high education had successful aging levels 1.462 times (OR=1.462, 95% CI=1.192-1.794) and 1.767 times (OR=1.767, 95% CI=1.401-2.229) higher, respectively. Heterogeneity analysis revealed that education had a positive and significant impact on successful aging in most elderly groups, with stronger effects for rural residents, females, younger elderly individuals, and those with low income (P < 0.05). Conclusion: This study shows that the level of successful aging among Chinese elderly is relatively low, and there are significant differences in successful aging levels across elderly groups with different education levels. Overall, education has a positive impact on successful aging among Chinese elderly individuals. Education is a critical factor in improving successful aging, especially for rural, female, younger, and low-income elderly individuals. By incorporating the Chinese experience, this research seeks to enrich the cross-cultural applicability of existing successful aging theories, provide empirical evidence to inform aging policies in developing countries Elderly Successful Aging Education China Impact Factor Analysis 1. Introduction Since the 21st century, global population structures have been undergoing an unprecedented transformation. In 2024, the global life expectancy at birth is projected to reach 73.3 years, an increase of 8.4 years since 1995. From 2023 to 2030, the number of people aged 60 and above is expected to rise from 1.1 billion to 1.4 billion [ 1 ]. According to the United Nations' World Population Prospects 2024, by the late 2070s, the global population aged 65 and older will exceed the population under the age of 18[ 2 ]. Population aging is not only prominent in developed economies, but many developing countries are also entering aging societies at a faster pace. In China, population aging has accelerated in recent decades. In 2001, the proportion of people aged 65 and above reached 7.1%, marking China's entry into an aging society[ 3 ]. By 2021, this proportion had increased to 14.2%, signaling deep aging. According to the United Nations' 2024 projections, this proportion will reach 20.0% by 2032[ 2 ]. Population aging has become one of the major social issues faced by countries and the world as a whole. To assess, explain, and predict the status, trends, and impacts of population aging, scholars have proposed numerous important research concepts and theoretical models, such as successful aging, healthy aging, active aging, productive aging, and Life Course Theory, Social Disengagement Theory, Continuity Theory, and Social Support Theory. Among these, successful aging and related models have garnered widespread attention and have had a significant impact. According to Rowe and Kahn's (1987) concept, successful aging is defined as high physical, psychological, and social functioning in old age without major diseases[ 4 ]. Based on Rowe and Kahn's model, some scholars have further developed other models, such as Fernandez-Ballesteros et al. (2008), who defined successful aging as involving health and activities of daily living (ADLs), physical and cognitive functions, social participation and involvement, as well as positive emotions and control[ 5 ]. Kleinedam et al. (2018) emphasized that successful aging should include physiological health, well-being, and social participation, incorporating both subjective and objective aspects[ 6 ]. Overall, successful aging is a multidimensional concept encompassing physical, functional, social, and psychological health[ 7 ]. Based on successful aging models, a series of measurements and studies have been conducted [ 8 ][ 9 ][ 10 ]. However, some scholars argue that the standards of successful aging proposed by Rowe and Kahn are too stringent, and few elderly individuals can meet these criteria[ 11 ]. Additionally, due to aging being influenced by specific socio-cultural concepts and behaviors, scholars from various countries and regions have developed measurement models and indicators adapted to their national contexts[ 12 ][ 13 ][ 14 ] . According to the Social Determinants of Health (SDH) theory, health is not only determined by genetic factors and healthcare services but is also influenced by a variety of social, economic, and environmental factors[ 15 ]. These factors can deeply affect health by influencing the living conditions, lifestyle, and resource access of individuals and groups. These factors include socio-economic status, cultural and social relationships, working and environmental conditions, health behaviors, policies, and systems, with education being a particularly prominent factor. Numerous studies have shown that education is one of the most important stable factors affecting health status [ 16 ][ 17 ][18[ 19 ][ 20 ][ 21 ]. Education improves the quality of life for older adults not only by enhancing health literacy, promoting healthy behaviors, and strengthening social networks and cognitive abilities, but also by significantly increasing their likelihood of achieving an active, independent, and meaningful life in later years [ 22 ][ 23 ][ 24 ][ 25 ]. However, aging is a complex social phenomenon that involves many dimensions, and successful aging is also a multidimensional concept. Therefore, the impact of education on successful aging differs from its effect on physical or psychological health. However, research on the impact of education on successful aging is currently limited. Moreover, existing research on successful aging has predominantly focused on high-income countries such as those in Europe and North America. Studies in developing countries, represented by China, remain limited, particularly lacking systematic analyses based on large samples that capture inter-generational differences and the influence of social structures. As a typical developing country, China’s current elderly population exhibits significant generational gaps and urban-rural disparities in educational attainment. With a large number of low-educated cohorts entering old age, these structural differences may profoundly affect their quality of life and capacity for social participation in later years. On the other hand, the Chinese government is actively promoting national strategies such as the “Active Response to Population Aging” and the “Healthy China 2030” initiative, which emphasize achieving healthy aging by enhancing the elderly’s comprehensive abilities and social engagement. Education stands out as one of the most modifiable and impactful variables within these efforts.Therefore, this study aims to describe the status of successful aging among the elderly population in China based on nationally representative survey data, examine whether and how education level influences the likelihood of successful aging, and further explore the heterogeneity of this relationship across gender, urban-rural residence, and economic income groups. By incorporating the Chinese experience, this research seeks to enrich the cross-cultural applicability of existing successful aging theories, provide empirical evidence to inform aging policies in developing countries, and offer policy recommendations for improving China’s education system and elderly health promotion mechanisms. 2. Materials and Methods 2.1 Data Sources This study utilizes the national data from the 2020 China Longitudinal Aging Social Survey (CLASS). The CLASS survey is a large-scale, nationwide, longitudinal social research project designed to comprehensively understand the basic personal and family conditions, health status, and economic situation of the elderly population in China. The survey covers seven major areas: personal basic information, health and related services, socio-economic status, retirement planning and social support, psychological well-being, family and children, and daily activities and fitness. The CLASS project officially commenced in 2014, with the baseline survey covering 28 provinces and municipalities across China (excluding Hainan, Tibet, and Xinjiang). The survey was conducted in 134 counties/districts and 462 villages/residential committees, obtaining 11,511 valid individual questionnaires and 462 community questionnaires. The respondents are Chinese citizens aged 60 and above. In this study, samples with missing data on key variables were excluded, and a total of 9,181 valid samples were included. 2.2 Variable Selection The overall educational level of elderly people in China is relatively low. Among the 9,181 elderly individuals in the sample, 21.05% are illiterate, 4.23% have only attended private schools or literacy classes, 37.13% have completed elementary school, 25.66% have completed junior high school, 9.28% have completed high school or vocational school, and the proportion of those with a college degree or higher is less than 3%. Based on this data, the educational levels in the sample are classified into three categories: low education level (including elementary school or below), medium education level (junior high school), and high education level (high school or above). According to the successful aging model proposed by Rowe and Kahn (1987), elderly individuals who meet all five of the following conditions—no major chronic diseases, no functional loss, normal cognitive function, no depression, and active participation in social activities—are defined as experiencing successful aging. The specific measurement criteria are as follows: (1)No major chronic diseases: An individual is considered free of major chronic diseases if they do not suffer from any one of the following five conditions: heart disease, diabetes, cerebrovascular disease, cancer, or chronic lung disease. (2)No functional loss: Functional loss is assessed using the Activities of Daily Living (ADLs) scale. If the respondent has no difficulty in any of the following seven daily activities: dressing, bathing, eating, controlling urination, controlling bowel movements, using the toilet, and getting out of bed, they are considered to have no functional loss. (3)Normal cognitive function: Cognitive function is assessed using the Mini-Mental State Examination (MMSE). Higher scores indicate better cognitive function, while lower scores may suggest cognitive decline, particularly symptoms associated with dementia. The simplified Chinese version of the MMSE has a total score range of 0–16, with 13–16 points indicating normal cognitive function, 10–12 points indicating mild cognitive impairment, 6–9 points indicating moderate cognitive impairment, and 0–5 points indicating severe cognitive impairment. In this study, 13–16 points were classified as normal cognitive function, and 0–12 points were classified as indicating cognitive problems. (4)No depression: Depression is assessed using the Chinese version of the Simplified CES-D scale, which measures depressive symptoms over the past week. The CES-D Chinese version consists of 9 questions, with each question offering 3 possible answers, scored 0–2 points each, for a total score range of 0–18 points. Scores of 0–6 points indicate no depression, 7–11 points suggest suspected depression, and 12–18 points indicate clear depression. In this study, scores of 0–6 points are considered as no depression, and scores of 7–18 points indicate the presence of depression. (5)Active participation in social activities: Respondents are asked whether they participated in any of the following 12 social activities in the past month: community security patrols, caring for others, environmental protection in the community, mediating neighborhood disputes, accompanying others for conversations, volunteer service, educating the younger generation, religious activities, senior university courses, singing or playing music, playing mahjong or chess, or participating in square dancing. Participation in one or more activities is considered as active participation in social activities. Following the five-level social-ecological model proposed by McLeroy (1988) and others, demographic variables, health status and behavior variables, as well as family, community, and policy variables are introduced as control variables for regression analysis. The demographic variables include: region, age, gender, and personal annual income. Health status and behavior variables include: self-rated health status, whether the individual has been hospitalized in the past two years, whether the individual engages in physical exercise weekly, and whether the individual currently smokes. Family, community, and policy environment variables include: family type, housing type, whether the residential community has outdoor activity areas, and whether the individual participates in basic pension insurance. 2.3 Statistical Analysis The study used SPSS 26.0 software for data analysis, with a significance level set at P < 0.05. First, descriptive statistical analysis was performed to compare the demographic characteristics of elderly individuals with different education levels. The success of aging and the status of five measurement dimensions among elderly individuals of varying educational levels were described, with differences assessed using the χ² test. Subsequently, multivariable logistic regression was conducted to analyze the effect of the independent variable, with demographic variables, health status and behavior variables, and family, community, and policy variables sequentially controlled. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the effect of different education levels on elderly individuals' success in aging were obtained. Finally, based on the previous analysis, heterogeneity analysis was conducted to further explore the differences in the impact of education on the successful aging of elderly individuals across different regions, genders, ages, and income levels. 3. Results 3.1 Demographic Characteristics of the Sample The sample in this study comprised a total of 9,181 individuals, with 5,730 (62.41%) elderly individuals having low education levels, 2,356 (25.66%) with medium education levels, and 1,095 (11.93%) with high education levels. The living areas, gender, age, and personal annual income of elderly individuals with different education levels are presented in Table 1, and the differences were statistically significant (P < 0.05). It can be observed that elderly individuals with low education levels are predominantly from rural areas, female, and belong to low-income groups, while those with higher education levels are mainly from urban areas, male, and under the age of 75. Table1 Demographic characteristic of older adults with different education levels 3.2 The successful aging levels and the status of the five measurement dimensions for elderly individuals with different education levels The successful aging level of the 9,181 elderly individuals in this study was 15.15% (1,391/9,181). Table 2 compares the successful aging levels, the absence of major chronic diseases, the absence of functional loss, normal cognitive function, absence of depression, and active participation in social activities among elderly individuals with different education levels, and the differences were statistically significant (P < 0.05). Through inter-group comparisons, it can be observed that the successful aging level of elderly individuals with low education was 11.06%, which is lower than the overall successful aging level of the sample and also lower than the successful aging levels of elderly individuals with medium education (20.20%) and high education (25.66%). The difference is highly significant (P < 0.01). Specifically, in the five dimensions of successful aging, elderly individuals with low education fared worse than those with medium and high education in terms of absence of major chronic diseases, functional loss, normal cognitive function, absence of depression, and active participation in social activities. Among these, in terms of absence of major chronic diseases, the proportion of elderly individuals with low education (64.87%) was lower than that of elderly individuals with medium education (64.94%) and high education (69.95%). Although the difference is relatively small, it is statistically significant (P < 0.01). Regarding functional loss, the proportion of elderly individuals with low education (85.38%) was lower than that of those with medium education (89.01%) and high education (88.31%). Although the difference is also relatively small, it is statistically highly significant (P < 0.01). In terms of normal cognitive function, the proportion of elderly individuals with low education (70.10%) was lower than that of those with medium education (82.00%) and high education (86.30%), and the difference is pronounced and statistically highly significant (P < 0.01). Similarly, in terms of absence of depression and active participation in social activities, the proportions of elderly individuals with low education (41.29%, 42.81%) were lower than those of elderly individuals with medium education (50.93%, 58.15%) and high education (60.73%, 64.29%), and the differences were prominent, with all differences being statistically highly significant (P < 0.01). Table2 Successful aging among older adults with different education levels 3.3 The multivariate logistic regression analysis of the impact of educational level on successful aging Table 3 presents the results of the logistic regression analysis on the impact of educational level on successful aging among Chinese elderly individuals. Model 1 is a univariate logistic regression analysis examining the effect of educational level on successful aging. Compared with elderly individuals with low education, those with high education are 2.518 times more likely to experience successful aging (OR=2.518, 95% CI=2.043–3.102), while those with medium education are 1.936 times more likely (OR=1.936, 95% CI=1.603–2.338). Model 2 controls for socio-demographic variables (residence, age, gender, income), and the likelihood of successful aging for elderly individuals with medium and high education is 1.581 times (OR=1.581, 95% CI=1.299–1.924) and 2.086 times (OR=2.086, 95% CI=1.677–2.595) greater than for those with low education, respectively. Model 3 further controls for health status and behavioral variables (health status, hospitalization history, physical activity, smoking behavior). After controlling for these variables, elderly individuals with medium and high education are 1.480 times (OR=1.480, 95% CI=1.210–1.811) and 1.818 times (OR=1.818, 95% CI=1.450–2.281) more likely to experience successful aging compared to those with low education. Model 4 additionally controls for family, community, and policy environment variables (family type, housing type, presence of outdoor activity spaces in the community, participation in basic pension insurance). In this model, elderly individuals with medium and high education are 1.462 times (OR=1.462, 95% CI=1.192–1.794) and 1.767 times (OR=1.767, 95% CI=1.401–2.229) more likely to experience successful aging than those with low education. It is evident that both medium and high educational levels have a significant positive impact on successful aging, even after controlling for other factors (P < 0.001). Elderly individuals with higher education are more likely to achieve successful aging compared to those with lower education, a pattern confirmed across all models. Furthermore, income, health status, hospitalization history, physical exercise, and community environment also have significant effects on successful aging. However, factors such as residence, gender, and participation in pension insurance do not show a significant impact on successful aging. Table3 Multivariate Logistic regression analysis on the association between education level and successful aging 3.4 Heterogeneity Analysis The results of the univariate analysis above show that there are significant differences in the levels of successful aging among elderly people in China with different educational backgrounds. The results of the multivariate logistic regression analysis indicate that education significantly affects successful aging in Chinese elderly people. Related research suggests that individual characteristics can influence successful aging. Therefore, the question arises: Does the effect of education on successful aging differ significantly across different groups of Chinese elderly? The following will conduct a heterogeneity analysis. Regional Heterogeneity. As shown in Table 4, the effect of education on successful aging among rural elderly people is 0.387 (P < 0.05), indicating that education has a significant positive effect on successful aging in rural areas. For urban elderly people, the effect of education is 0.264 (P < 0.01), showing that education has a very significant positive effect on successful aging in urban areas. At the same time, the data also suggest that the promoting effect of education on successful aging is stronger in rural elderly people. This may be due to the relatively limited healthcare resources in rural China, where the improvement in health literacy brought about by education is more significant. Gender Heterogeneity. Similar to the regional heterogeneity, Table 4 shows that education has a very significant effect on the successful aging of both male and female elderly people in China. The effect of education on successful aging among male elderly is 0.228 (P < 0.01), indicating that education has a significant positive effect on successful aging in men. The effect of education on female elderly people is 0.354 (P < 0.01), showing that education has a stronger influence on the successful aging of women with higher significance. Age Heterogeneity. As shown in Table 4, the effect of education on successful aging varies significantly across different age groups. For elderly people aged 60–74, the effect of education is 0.302 (P < 0.01), indicating that education has a very significant positive effect on successful aging in this group. However, for elderly people aged 75 and above, the effect of education is not significant. This is likely due to the fact that at older ages, physical decline primarily dominates health, and the cognitive and social advantages brought by education diminish. Income Heterogeneity. Among low-income elderly people, the effect of education is 0.365 (P < 0.01), indicating that education has a very significant positive effect on successful aging in this group. However, for middle-income elderly people, the effect of education is not significant, suggesting that education does not have a significant impact on successful aging in this group. For high-income elderly people, the effect of education is 0.276 (P < 0.1), suggesting that education has a slight positive effect on successful aging in the high-income elderly group. Overall, education has a positive and significant impact on successful aging in most elderly groups, with stronger effects in rural areas, among women, younger elderly, and low-income elderly people. However, for elderly people aged 75 and above and middle-income elderly, the effect of education on successful aging is not significant. For high-income elderly people, the effect of education on successful aging is weaker. Table 4-1 Heterogeneity Analysis of the Impact of education level on successful aging Among older adults 4. Discussion This study finds that the level of successful aging among elderly individuals in China in 2020 was 15.15% (1391/9181), which is comparable to measurements made by other Chinese scholars in recent years [27]. Compared to the 14.41% success rate measured by You et al.[28]using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS), this figure shows a slight increase. However, compared to other countries, especially developed nations, the level of successful aging among elderly individuals in China remains relatively low. Nakagawa et al. [10]used national population sampling data from China, South Korea, and Japan to demonstrate differences in the levels of successful aging among elderly populations in these countries. The level of successful aging in China was found to be 15.7%, while in South Korea, it was 25.5%, and in Japan, it was 29.2%. It can be seen that the data from this study are close to the levels of successful aging among elderly individuals in China from the studies mentioned above. However, these studies were based on data from the Chinese elderly population in 2011, meaning that after nearly a decade, there has been little change in the successful aging level of elderly people in China, though there remains a significant gap compared to the levels observed in elderly individuals in Japan and South Korea 10 years ago. How can the differences in the levels of successful aging among the elderly in China, South Korea, and Japan be explained? Nakagawa [10]argues that, in addition to differences in healthcare systems and economic conditions, a key factor is the difference in education systems. Compared to the other two countries, China's compulsory education system was implemented later. China began nationwide compulsory education in 1986 and did not achieve universal nine-year education until 2011. According to the seventh national population census of China in 2020, the average years of education for the population aged 15 and above was 9.91 years [29]. The fifth China Urban and Rural Elderly Living Conditions Survey in 2021 shows that, among elderly people aged 60 and above, 61.0% have received education only up to elementary school or lower, 23.3% have completed middle school, 11.9% have completed high school (including technical schools and secondary vocational schools), and only 3.7% have a college education or higher. These figures align closely with those of the present study, indicating that the overall educational level of elderly individuals in China is currently quite low. It can be preliminarily concluded that the lower level of successful aging in China is strongly related to the relatively low educational attainment of the elderly population. Further analysis reveals that elderly individuals in China with lower educational levels are more likely to live in rural areas, be female, and have lower incomes. These characteristics reflect typical features of populations in developing countries. China's long-standing urban-rural dualism has led to a severe disparity in educational resources between rural and urban areas. Before 1980, rural populations generally had limited access to secondary or higher education, particularly women. The generations of elderly individuals in China (born between the 1950s and 1970s) grew up during a period of extreme scarcity in educational resources, with low levels of education in rural areas, where many women did not even complete elementary school. This resulted in a concentration of lower-educated elderly individuals in rural areas, while urban elderly people, who had access to better educational resources earlier, tend to have higher educational levels. Additionally, in China's traditional agricultural society, rural families prioritized the education of male children over female children, with women often assigned household or agricultural duties. The prevailing "son preference" led to systematic deprivation of educational opportunities for women. When rural households faced limited resources, male children were prioritized for education to take on family responsibilities, while women were married early or worked in agriculture, further widening the educational gender gap. These factors have contributed to a significant educational disparity between elderly women and men in China. Finally, there is a cyclical relationship between education level and income, as lower-educated individuals are more likely to engage in agriculture or manual labor, earning lower incomes and lacking social security. For example, rural pensions in China are only about one-tenth of those in urban areas [30]. Low-income families struggle to invest in the education of their descendants, creating a "low education–low income" vicious cycle. The fact that elderly individuals with low educational levels in China are more likely to live in rural areas, have a higher proportion of women, and a higher proportion of low-income individuals reflects the historically unequal distribution of educational opportunities, especially in rural and female populations. These factors combined result in lower-educated elderly individuals facing greater social and health challenges, which negatively affect their level of successful aging. This study shows that the level of successful aging among elderly individuals with low education is only 11.06%, far lower than that of individuals with middle education (20.20%) or high education (25.66%). Looking specifically at several dimensions of successful aging, the study reveals that elderly individuals in China with higher educational levels perform better across all dimensions of successful aging. Elderly individuals with middle and high education levels are significantly more likely to be free of major chronic diseases, experience no functional loss, have normal cognitive function, be free of depression, and actively participate in social activities compared to those with lower education levels, especially in cognitive function, depression, and social participation. Regarding chronic diseases and functional loss, according to the Social Determinants of Health Theory, an individual's health is not only influenced by biological and genetic factors but also by social, economic, and environmental factors. Education is considered one of the social determinants of health. Those with higher education levels typically have access to more resources, better social support, and more health information, which enables them to better prevent and manage diseases[1]. Multiple studies have shown that elderly individuals with lower education levels report poorer health[17] [18]and are more likely to suffer from chronic diseases, such as cardiovascular diseases, diabetes, and respiratory diseases[31][32]. Epidemiological surveys also indicate that elderly individuals with lower education levels are more likely to experience functional loss, with lower-educated elderly populations generally reporting more activity limitations and disabilities [33][20]. This study shows that among elderly individuals with higher education, 69.95% report no major chronic diseases, the highest proportion, while the lowest proportion of 64.87% is found among those with lower education. Additionally, 88.31% of elderly individuals with higher education report no functional loss, slightly lower than the 89.01% among those with middle education, while the lowest proportion (85.38%) is found among those with lower education. These findings indicate that elderly individuals with higher education levels fare better than those with lower education in terms of chronic diseases and functional loss. In terms of cognitive function, Alwin and McCammon[34]found that individuals born in different eras, due to variations in social education levels, had different opportunities and quality of education, which resulted in generational differences in cognitive abilities. People with higher education levels tend to have better cognitive reserves, which can delay cognitive decline, and they show milder symptoms even in the presence of pathological changes associated with aging (such as pre-Alzheimer's disease). Education promotes cognitive stimulation, enhancing higher-level cognitive skills like comprehension, reasoning, and memory, which are crucial for resisting cognitive deterioration in old age. This study finds that 29.90% of elderly individuals in China with lower education levels experience cognitive issues, significantly higher than those with middle (20.20%) or high (16.50%) education. This finding aligns with the results of Li et al.[35], further supporting the notion that education level positively influences cognitive abilities in the elderly. In terms of depression, this study shows that 47.77% of elderly individuals in China exhibit suspicious depressive symptoms, and 6.14% show clear signs of depression, figures similar to those found by Zhang et al.[27]. Numerous studies have found that education has a positive effect on mental health. Elderly individuals with higher education levels tend to have better knowledge and skills to regulate their negative emotions, leading to greater life satisfaction and better psychological health [21]. Ranchor et al. found that individuals' mental health varies according to their education level[36]. Liu et al. also found that elderly individuals with higher education levels are better at self-regulating to reduce loneliness, thereby achieving better mental health[37]. This study finds that 58.71% of elderly individuals with lower education levels experience depression, far higher than the 49.07% of those with middle education and 39.27% of those with high education. Thus, education plays an active role in reducing depressive symptoms, with elderly individuals with higher education levels being less likely to experience depression and more likely to achieve successful aging. In terms of social participation, this study found that the proportion of Chinese elderly with low education levels actively participating in social activities was 42.81%, which is significantly lower than the proportion for those with medium education (58.15%) and high education (64.29%). This finding is consistent with the research by Peng et al. [38], which examined the relationship between the education levels of middle-aged and elderly Chinese residents and the occurrence of disability. Their study found that the participation rate in social activities was lower among the illiterate elderly compared to the literate elderly. Moreover, illiterate individuals were at a higher risk of experiencing disability than their literate counterparts. Other studies have shown that middle-aged and elderly individuals who are "female," "urban residents," "higher income," and "higher education" are more likely to engage in social activities [39]. Educated individuals are more inclined to participate in social activities, and education level is a key factor in determining the likelihood of disability, primarily through its influence on social participation[38]. Therefore, education influences the probability of elderly individuals participating in social activities, and participation in social activities is associated with both their psychological health and physical disability. Chinese elderly individuals with higher education levels are more likely to engage in social activities, which in turn increases the likelihood of successful aging. Overall, elderly Chinese individuals with higher education levels perform better across various aspects of successful aging, including the presence of major chronic diseases, functional loss, cognitive function, depressive symptoms, and social participation, compared to those with lower education levels. These differences highlight the critical role that education plays in the health and successful aging of the elderly. Elderly individuals with higher education not only perform better in terms of physical health (such as chronic diseases and functional loss), but they also exhibit more positive outcomes in mental health (such as depression) and social activity participation. Health behaviors are influenced not only by individual factors but also by the interaction of social, environmental, and cultural factors[26]. Similarly, the aging status of the elderly can be seen as being influenced by multiple variables, including personal, family, community, and policy factors. This study shows that education is an important and stable predictor of successful aging, with its effects partially mediated by health behaviors, economic resources, and the community environment. Firstly, education not only improves elderly individuals’health behaviors but also enhances their knowledge and management of health, which is crucial for successful aging. Secondly, education interacts with other factors such as income and health status, collectively influencing successful aging. Higher income and better health can amplify the positive effects of education, making it easier for elderly individuals to enjoy a high-quality later life. Lastly, community environment, health behaviors, and social security policies positively influence successful aging for elderly individuals with higher education levels. Those with higher education are more likely to participate in community activities and access social security resources, thus increasing their social support and sense of participation, which contributes to successful aging. 5. Conclusion In summary, the level of successful aging among Chinese elderly individuals is relatively low, with significant differences in successful aging levels across different education groups. Overall, education has a positive impact on successful aging among the elderly in China. Higher education levels are generally associated with better health, stronger social adaptability, and greater social resources, all of which contribute to improving the quality of life and mental health of elderly individuals. These factors help alleviate the health, economic, and social isolation challenges faced by the elderly, enabling them to better adapt to the aging process. Education is a key factor in enhancing successful aging, with its impact being particularly pronounced for rural elderly, women, younger elderly individuals, and those with lower incomes. In the future, as population aging accelerates in developing countries such as China, the impact of education on successful aging among the elderly in these countries will become increasingly important. Strengthening elderly education and lifelong learning systems, as well as promoting social awareness and support for education in later life, will help mitigate the social and economic challenges brought by aging and contribute to the holistic development and well-being of the elderly population. Abbreviations CLASS=China Longitudinal Aging Social Survey WHO = World Health Organization UN = United Nations ADLs=Activities of daily living SDH=Social Determinants of Health MMSE=Mini-Mental State Examination CES-D=Center for Epidemiologic Studies Depression Scale ORs=odds ratios CIs=confidence intervals CHARLS=China Health and Retirement Longitudinal Study STATS=National Bureau of Statistics MOHRSS=Ministry of Human Resources and Social Security Declarations Ethics approval and consent to participate China Longitudinal Aging Social Survey (CLASS)was conducted with the approval of the Ethical Review Committee of Renmin University of China. The survey data remained anonymous, and participants’ responses were protected under privacy law.Additionally, each participant provided signed informed consent in accordance with the Helsinki Declaration at the time of participation. As the survey was already ethically approved, there was no need for further ethics approval for those using the data as authorized users. Consent for publication Not applicable Data availability The CLASS datasets are publicly available at Renmin University of China Open Research Data platform (http://cgss.ruc.edu.cn/). Researchers can obtain these data after submitting a data use agreement to the CLASS team. Competing Interests Not applicable Funding No Funding Author contributions HG conceived and designed the research, provided guidance throughout the entire research process, and responsible for all R&R works. QT and YG participated in data analysis, wrote and supplemented the English paper. HH reviewed and edited the paper. All authors contributed to the article and approved the submitted version. Acknowledgments The authors sincerely thank the participants of this study and the date providers of China Longitudinal Aging Social Survey (CLASS). References WHO. (2025). Population Ageing . Available at: https://www.who.int/en/news-room/questions-and-answers/item/population-ageing. UN.(2025). World Population Prospects 2024 . Available at: https://www.un.org/development/desa/pd/world-population-prospects-2024 Zheng, B. W. (2025). The Situation and Trends of Global Population Ageing: International Comparisons of Response Measures and Key Insights . Available at: http://www.cisscass.com/lunweninfo.aspx?ids=216&fl=14. J W Rowe, R L Kahn.(1987). Human aging: usual and successful .Science, 237(4811), 143-9.doi: 10.1126/science.3299702. Fernández-Ballesteros, R., García, L. F., Abarca, D., et al. (2008). Lay concept of aging well: Cross-cultural comparisons . Journal of the American Geriatrics Society, 56(5):950–952. doi: 10.1111/j.1532-5415.2008.01654.x. Kleinedam L, Thoma M, Maercker A, et al.(2018). What is successful aging? A Psychometric validation study of different construct definitions . Gerontologist, 59(4):738-748. doi: 10.1093/geront/gny083. Urtamo A, Jyväkorpi S, Strandberg T.(2019). Definitions of successful ageing: A brief review of a multidimensional concept . Acta Biomed,90(2):359–363. doi: 10.23750/abm.v90i2.8376. Chou, K. L. and Chi, I. (2002). Successful aging among the young-old, old-old, and oldest-old Chinese . International Journal of Aging and Human Development, 54(1):1-14. doi: 10.2190/9K7T-6KXM-C0C6-3D64 Karsten Hank.(2011). How “Successful” Do Older Europeans Age? Findings From SHARE . The Journals of Gerontology, 66B(2):230–236. doi:10.1093/geronb/gbq089 Nakagawa, T., Cho, J., & Yeung, D. Y. (2021). Successful aging in East Asia: Comparison among China, Korea, and Japan . Journals of Gerontology,76(S1):S17–S26. doi: 10.1093/geronb/gbaa042 McLaughlin SJ, Connell CM, Heeringa SG, Li LW, Roberts JS.(2010). Successful aging in the United States: Prevalence estimates from a national sample of older adults .The Journals of Gerontology: Series B, The Gerontological Society of America, 65(2):216-226. doi: 10.1093/geronb/gbp101. Lin, L. H. (2006). A Study on Successful Aging of Older Learners in Taiwan. Population Research Journal, 33, 133-170. Lee, J. E., Kahana, B., & Kahana, E. (2017). Successful aging from the viewpoint of older adults: Development of a brief successful aging inventory (SAI) . Gerontology, 63(4):359-371. doi: 10.1159/000455252 Zanjari, N., Sharifian Sani, M., Hosseini-Chavoshi, M., Rafiey, H., & Mohammadi-Shahboulaghi, F. (2019). Development and Validation of Successful Aging Instrument . Iranian Rehabilitation Journal, 17(2): 129-140. doi: 10.32598/irj.17.2.129 WHO.(2025). Social determinants of health .Available at: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 Cutler, D. M., & Lleras-Muney, A. (2006). Education and health: Evaluating theories and evidence (NBER Working Paper No. 12352). National Bureau of Economic Research. https://www.nber.org/papers/w12352 Mirowsky, J., & Ross, C. E. (2008). Education and self-rated health: Cumulative advantage and its rising importance . Research on Aging, 30(1): 93–122. doi: 10.1177/0164027507309649 Zajacova A. , Hummer RA. , Rogers RG. (2012). Education and health among U.S. working-age adults: a detailed portrait across the full educational-attainment spectrum. Biodemography and Social Biology 58(1): 40-61. doi:10.1080/19485565.2012.666122 Mitchell, U. A., Ailshire, J. A., Brown, L. L., Levine, M. E., & Crimmins, E. M. (2016). Education and psychosocial functioning among older adults: 4-year change in sense of control and hopelessness . The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 73(5), 849–859. doi.org:10.1093/geronb/gbw031 Yuping Tsai.(2017). Education and disability trends of older Americans, 2000–2014. Journal of Public Health 39(3): 447-454. doi: 10.1093/pubmed/fdw082 Li, X., & Zhao, X. D. (2020). How Does Education Affect the Health Levels of Older Adults in China ? Finance and Economics Research, 46(3), 139-153. Crimmins, E. M., & Saito, Y. (2001). Trends in healthy life expectancy in the United States, 1970–1990: Gender, racial, and educational differences. Social Science & Medicine, 52(11), 1629–1641. doi:10.1016/S0277-9536(00)00273-2 Meeks, S., & Murrell, S. A. (2001). Contribution of education to health and life satisfaction in older adults mediated by negative affect . Journal of Aging and Health, 13(1). doi:10.1177/089826430101300105 Cutler, D. M., & Lleras-Muney, A. (2009). Understanding differences in health behaviors by education . Journal of Health Economics, 29(1), 1-28. doi:10.1016/j.jhealeco.2009.10.003 Raghupathi, V., & Raghupathi, W. (2020). The influence of education on health: An empirical assessment of OECD countries for the period 1995-2015. Arch Public Health, 78, 20.doi:10.1186/s13690-020-00402-5 McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs . Health Education Quarterly, 15(4): 351–377. doi: 10.1177/109019818801500401. Zhang, Y., Wen, X., Yang, Z., Du, X., Deng, C., Ye, Q., Deng, R., & Huang, Y. (2024). The Impact of Different Family Income Levels on Elderly Successful Aging . Chinese General Practice, 27(08), 930-935. doi: 10.12114/j.issn.1007-9572.2023.0430 You, Y., & Xia, K. (2020). Analysis of the Status and Influencing Factors of Successful Aging Among Older Adults in Different Regions of China — An Empirical Study Based on CHARLS Data . Modern Preventive Medicine, 47(11), 2021-2034. National Bureau of Statistics. (2021). The Bulletin of the Seventh National Census (No. 6) - Population Education Status . Available at: https://www.stats.gov.cn/sj/tjgb/rkpcgb/qgrkpcgb/202302/t20230206_1902006.html Ministry of Human Resources and Social Security. (2024). Statistical Bulletin on the Development of Human Resources and Social Security in 2023.Available at: https://www.mohrss.gov.cn/xxgk2020/fdzdgknr/ghtj/tj/ndtj/202406/t20240617_520366.html Johnson-Lawrence V., Zajacova A., Sneed R. 68. (2017). Education, race/ethnicity, and multimorbidity among adults aged 30–64 in the National Health Interview Survey. SSM Popul Health, 29(3):366-372.b doi:10.1016/j.ssmph.2017.03.007. Quiñones AR. , Markwardt S. , Botoseneanu A. (2016). Multimorbidity combinations and disability in older adults . The Journals of Gerontology: Series A,71(6): 823–830. doi: 10.1093/gerona/glw035 Schoeni RF. , Freedman VA. , Wallace RB. (2001). Persistent, Consistent, Widespread, and Robust? Another Look at Recent Trends in Old-Age Disability . The Journals of Gerontology: Series B, 56(4):S206–S218, doi:10.1093/geronb/56.4.S206 Alwin, D. F., & McCammon, R. J. (2001). Aging, cohorts, and verbal ability . Journals of Gerontology: Psychological Sciences and Social Sciences, 56(3): S151–S161. doi: 10.1093/geronb/56.3.s151 Li, G., Tian, H., Yao, C., & Lou, F. (2023). The Current Status and Influencing Factors of Cognitive Function in Chinese Elderly . Nursing Science, 12(4), 597-604. Ranchor A V，Bouma J，Sanderman R.(1996). Vulnerability and social class ： Differential patterns of personality and social support over the social classes . Personality and Individual Differences. 20(2):229−237. Liu, J., Xu, H., & Song, S. (2009). The Relationship Between Loneliness in Older Adults and Parental Support and Filial Piety Expectations . Chinese Journal of Clinical Psychology, (5), 636-638. Peng, S., Fu, X., & Feng, X. (2021). Education Level and Disability Occurrence Among Middle-Aged and Elderly Chinese Residents: The Mediating Role of Social Participation . Peking University Medical Journal, 53(3), 549-554. doi:10.19723/j.issn.1671-167X.2021.03.018. Feng Z, Cramm JM, Jin c, et al.(2020). The longitudinal relationship between income and social participation among chinese older people . SSM Popul Health.11:100636. doi: 10.1016/j.ssmph.2020.100636 Tables Tables 1 to 4 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Introduction","content":"\u003cp\u003eSince the 21st century, global population structures have been undergoing an unprecedented transformation. In 2024, the global life expectancy at birth is projected to reach 73.3 years, an increase of 8.4 years since 1995. From 2023 to 2030, the number of people aged 60 and above is expected to rise from 1.1\u0026nbsp;billion to 1.4\u0026nbsp;billion [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the United Nations' World Population Prospects 2024, by the late 2070s, the global population aged 65 and older will exceed the population under the age of 18[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Population aging is not only prominent in developed economies, but many developing countries are also entering aging societies at a faster pace. In China, population aging has accelerated in recent decades. In 2001, the proportion of people aged 65 and above reached 7.1%, marking China's entry into an aging society[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. By 2021, this proportion had increased to 14.2%, signaling deep aging. According to the United Nations' 2024 projections, this proportion will reach 20.0% by 2032[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Population aging has become one of the major social issues faced by countries and the world as a whole.\u003c/p\u003e \u003cp\u003eTo assess, explain, and predict the status, trends, and impacts of population aging, scholars have proposed numerous important research concepts and theoretical models, such as successful aging, healthy aging, active aging, productive aging, and Life Course Theory, Social Disengagement Theory, Continuity Theory, and Social Support Theory. Among these, successful aging and related models have garnered widespread attention and have had a significant impact. According to Rowe and Kahn's (1987) concept, successful aging is defined as high physical, psychological, and social functioning in old age without major diseases[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Based on Rowe and Kahn's model, some scholars have further developed other models, such as Fernandez-Ballesteros et al. (2008), who defined successful aging as involving health and activities of daily living (ADLs), physical and cognitive functions, social participation and involvement, as well as positive emotions and control[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Kleinedam et al. (2018) emphasized that successful aging should include physiological health, well-being, and social participation, incorporating both subjective and objective aspects[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Overall, successful aging is a multidimensional concept encompassing physical, functional, social, and psychological health[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Based on successful aging models, a series of measurements and studies have been conducted [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e][\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, some scholars argue that the standards of successful aging proposed by Rowe and Kahn are too stringent, and few elderly individuals can meet these criteria[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, due to aging being influenced by specific socio-cultural concepts and behaviors, scholars from various countries and regions have developed measurement models and indicators adapted to their national contexts[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e][\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e][\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eAccording to the Social Determinants of Health (SDH) theory, health is not only determined by genetic factors and healthcare services but is also influenced by a variety of social, economic, and environmental factors[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These factors can deeply affect health by influencing the living conditions, lifestyle, and resource access of individuals and groups. These factors include socio-economic status, cultural and social relationships, working and environmental conditions, health behaviors, policies, and systems, with education being a particularly prominent factor. Numerous studies have shown that education is one of the most important stable factors affecting health status [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e][\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e][18[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e][\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e][\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Education improves the quality of life for older adults not only by enhancing health literacy, promoting healthy behaviors, and strengthening social networks and cognitive abilities, but also by significantly increasing their likelihood of achieving an active, independent, and meaningful life in later years [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e][\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e][\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e][\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, aging is a complex social phenomenon that involves many dimensions, and successful aging is also a multidimensional concept. Therefore, the impact of education on successful aging differs from its effect on physical or psychological health. However, research on the impact of education on successful aging is currently limited. Moreover, existing research on successful aging has predominantly focused on high-income countries such as those in Europe and North America. Studies in developing countries, represented by China, remain limited, particularly lacking systematic analyses based on large samples that capture inter-generational differences and the influence of social structures.\u003c/p\u003e \u003cp\u003eAs a typical developing country, China\u0026rsquo;s current elderly population exhibits significant generational gaps and urban-rural disparities in educational attainment. With a large number of low-educated cohorts entering old age, these structural differences may profoundly affect their quality of life and capacity for social participation in later years. On the other hand, the Chinese government is actively promoting national strategies such as the \u0026ldquo;Active Response to Population Aging\u0026rdquo; and the \u0026ldquo;Healthy China 2030\u0026rdquo; initiative, which emphasize achieving healthy aging by enhancing the elderly\u0026rsquo;s comprehensive abilities and social engagement. Education stands out as one of the most modifiable and impactful variables within these efforts.Therefore, this study aims to describe the status of successful aging among the elderly population in China based on nationally representative survey data, examine whether and how education level influences the likelihood of successful aging, and further explore the heterogeneity of this relationship across gender, urban-rural residence, and economic income groups. By incorporating the Chinese experience, this research seeks to enrich the cross-cultural applicability of existing successful aging theories, provide empirical evidence to inform aging policies in developing countries, and offer policy recommendations for improving China\u0026rsquo;s education system and elderly health promotion mechanisms.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data Sources\u003c/h2\u003e \u003cp\u003eThis study utilizes the national data from the 2020 China Longitudinal Aging Social Survey (CLASS). The CLASS survey is a large-scale, nationwide, longitudinal social research project designed to comprehensively understand the basic personal and family conditions, health status, and economic situation of the elderly population in China. The survey covers seven major areas: personal basic information, health and related services, socio-economic status, retirement planning and social support, psychological well-being, family and children, and daily activities and fitness. The CLASS project officially commenced in 2014, with the baseline survey covering 28 provinces and municipalities across China (excluding Hainan, Tibet, and Xinjiang). The survey was conducted in 134 counties/districts and 462 villages/residential committees, obtaining 11,511 valid individual questionnaires and 462 community questionnaires. The respondents are Chinese citizens aged 60 and above. In this study, samples with missing data on key variables were excluded, and a total of 9,181 valid samples were included.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Variable Selection\u003c/h2\u003e \u003cp\u003eThe overall educational level of elderly people in China is relatively low. Among the 9,181 elderly individuals in the sample, 21.05% are illiterate, 4.23% have only attended private schools or literacy classes, 37.13% have completed elementary school, 25.66% have completed junior high school, 9.28% have completed high school or vocational school, and the proportion of those with a college degree or higher is less than 3%. Based on this data, the educational levels in the sample are classified into three categories: low education level (including elementary school or below), medium education level (junior high school), and high education level (high school or above).\u003c/p\u003e \u003cp\u003eAccording to the successful aging model proposed by Rowe and Kahn (1987), elderly individuals who meet all five of the following conditions\u0026mdash;no major chronic diseases, no functional loss, normal cognitive function, no depression, and active participation in social activities\u0026mdash;are defined as experiencing successful aging. The specific measurement criteria are as follows:\u003c/p\u003e \u003cp\u003e(1)No major chronic diseases: An individual is considered free of major chronic diseases if they do not suffer from any one of the following five conditions: heart disease, diabetes, cerebrovascular disease, cancer, or chronic lung disease.\u003c/p\u003e \u003cp\u003e(2)No functional loss: Functional loss is assessed using the Activities of Daily Living (ADLs) scale. If the respondent has no difficulty in any of the following seven daily activities: dressing, bathing, eating, controlling urination, controlling bowel movements, using the toilet, and getting out of bed, they are considered to have no functional loss.\u003c/p\u003e \u003cp\u003e(3)Normal cognitive function: Cognitive function is assessed using the Mini-Mental State Examination (MMSE). Higher scores indicate better cognitive function, while lower scores may suggest cognitive decline, particularly symptoms associated with dementia. The simplified Chinese version of the MMSE has a total score range of 0\u0026ndash;16, with 13\u0026ndash;16 points indicating normal cognitive function, 10\u0026ndash;12 points indicating mild cognitive impairment, 6\u0026ndash;9 points indicating moderate cognitive impairment, and 0\u0026ndash;5 points indicating severe cognitive impairment. In this study, 13\u0026ndash;16 points were classified as normal cognitive function, and 0\u0026ndash;12 points were classified as indicating cognitive problems.\u003c/p\u003e \u003cp\u003e(4)No depression: Depression is assessed using the Chinese version of the Simplified CES-D scale, which measures depressive symptoms over the past week. The CES-D Chinese version consists of 9 questions, with each question offering 3 possible answers, scored 0\u0026ndash;2 points each, for a total score range of 0\u0026ndash;18 points. Scores of 0\u0026ndash;6 points indicate no depression, 7\u0026ndash;11 points suggest suspected depression, and 12\u0026ndash;18 points indicate clear depression. In this study, scores of 0\u0026ndash;6 points are considered as no depression, and scores of 7\u0026ndash;18 points indicate the presence of depression.\u003c/p\u003e \u003cp\u003e(5)Active participation in social activities: Respondents are asked whether they participated in any of the following 12 social activities in the past month: community security patrols, caring for others, environmental protection in the community, mediating neighborhood disputes, accompanying others for conversations, volunteer service, educating the younger generation, religious activities, senior university courses, singing or playing music, playing mahjong or chess, or participating in square dancing. Participation in one or more activities is considered as active participation in social activities.\u003c/p\u003e \u003cp\u003eFollowing the five-level social-ecological model proposed by McLeroy (1988) and others, demographic variables, health status and behavior variables, as well as family, community, and policy variables are introduced as control variables for regression analysis. The demographic variables include: region, age, gender, and personal annual income. Health status and behavior variables include: self-rated health status, whether the individual has been hospitalized in the past two years, whether the individual engages in physical exercise weekly, and whether the individual currently smokes. Family, community, and policy environment variables include: family type, housing type, whether the residential community has outdoor activity areas, and whether the individual participates in basic pension insurance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe study used SPSS 26.0 software for data analysis, with a significance level set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. First, descriptive statistical analysis was performed to compare the demographic characteristics of elderly individuals with different education levels. The success of aging and the status of five measurement dimensions among elderly individuals of varying educational levels were described, with differences assessed using the χ\u0026sup2; test. Subsequently, multivariable logistic regression was conducted to analyze the effect of the independent variable, with demographic variables, health status and behavior variables, and family, community, and policy variables sequentially controlled. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the effect of different education levels on elderly individuals' success in aging were obtained. Finally, based on the previous analysis, heterogeneity analysis was conducted to further explore the differences in the impact of education on the successful aging of elderly individuals across different regions, genders, ages, and income levels.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003ch1\u003e3.1 Demographic Characteristics of the Sample\u003c/h1\u003e\n\u003cp\u003eThe sample in this study comprised a total of 9,181 individuals, with 5,730 (62.41%) elderly individuals having low education levels, 2,356 (25.66%) with medium education levels, and 1,095 (11.93%) with high education levels. The living areas, gender, age, and personal annual income of elderly individuals with different education levels are presented in Table 1, and the differences were statistically significant (P \u0026lt; 0.05). It can be observed that elderly individuals with low education levels are predominantly from rural areas, female, and belong to low-income groups, while those with higher education levels are mainly from urban areas, male, and under the age of 75.\u003c/p\u003e\n\u003cp\u003eTable1 Demographic characteristic of older adults with different education levels\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 The successful aging levels and the status of the five measurement dimensions for elderly individuals with different education levels\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe successful aging level of the 9,181 elderly individuals in this study was 15.15% (1,391/9,181). Table 2 compares the successful aging levels, the absence of major chronic diseases, the absence of functional loss, normal cognitive function, absence of depression, and active participation in social activities among elderly individuals with different education levels, and the differences were statistically significant (P \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eThrough inter-group comparisons, it can be observed that the successful aging level of elderly individuals with low education was 11.06%, which is lower than the overall successful aging level of the sample and also lower than the successful aging levels of elderly individuals with medium education (20.20%) and high education (25.66%). The difference is highly significant (P \u0026lt; 0.01). Specifically, in the five dimensions of successful aging, elderly individuals with low education fared worse than those with medium and high education in terms of absence of major chronic diseases, functional loss, normal cognitive function, absence of depression, and active participation in social activities.\u003c/p\u003e\n\u003cp\u003eAmong these, in terms of absence of major chronic diseases, the proportion of elderly individuals with low education (64.87%) was lower than that of elderly individuals with medium education (64.94%) and high education (69.95%). Although the difference is relatively small, it is statistically significant (P \u0026lt; 0.01). Regarding functional loss, the proportion of elderly individuals with low education (85.38%) was lower than that of those with medium education (89.01%) and high education (88.31%). Although the difference is also relatively small, it is statistically highly significant (P \u0026lt; 0.01). In terms of normal cognitive function, the proportion of elderly individuals with low education (70.10%) was lower than that of those with medium education (82.00%) and high education (86.30%), and the difference is pronounced and statistically highly significant (P \u0026lt; 0.01). Similarly, in terms of absence of depression and active participation in social activities, the proportions of elderly individuals with low education (41.29%, 42.81%) were lower than those of elderly individuals with medium education (50.93%, 58.15%) and high education (60.73%, 64.29%), and the differences were prominent, with all differences being statistically highly significant (P \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003eTable2 Successful aging among older adults with different education levels\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 The multivariate logistic regression analysis of the impact of educational level on successful aging\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presents the results of the logistic regression analysis on the impact of educational level on successful aging among Chinese elderly individuals. Model 1 is a univariate logistic regression analysis examining the effect of educational level on successful aging. Compared with elderly individuals with low education, those with high education are 2.518 times more likely to experience successful aging (OR=2.518, 95% CI=2.043\u0026ndash;3.102), while those with medium education are 1.936 times more likely (OR=1.936, 95% CI=1.603\u0026ndash;2.338).\u003c/p\u003e\n\u003cp\u003eModel 2 controls for socio-demographic variables (residence, age, gender, income), and the likelihood of successful aging for elderly individuals with medium and high education is 1.581 times (OR=1.581, 95% CI=1.299\u0026ndash;1.924) and 2.086 times (OR=2.086, 95% CI=1.677\u0026ndash;2.595) greater than for those with low education, respectively.\u003c/p\u003e\n\u003cp\u003eModel 3 further controls for health status and behavioral variables (health status, hospitalization history, physical activity, smoking behavior). After controlling for these variables, elderly individuals with medium and high education are 1.480 times (OR=1.480, 95% CI=1.210\u0026ndash;1.811) and 1.818 times (OR=1.818, 95% CI=1.450\u0026ndash;2.281) more likely to experience successful aging compared to those with low education.\u003c/p\u003e\n\u003cp\u003eModel 4 additionally controls for family, community, and policy environment variables (family type, housing type, presence of outdoor activity spaces in the community, participation in basic pension insurance). In this model, elderly individuals with medium and high education are 1.462 times (OR=1.462, 95% CI=1.192\u0026ndash;1.794) and 1.767 times (OR=1.767, 95% CI=1.401\u0026ndash;2.229) more likely to experience successful aging than those with low education.\u003c/p\u003e\n\u003cp\u003eIt is evident that both medium and high educational levels have a significant positive impact on successful aging, even after controlling for other factors (P \u0026lt; 0.001). Elderly individuals with higher education are more likely to achieve successful aging compared to those with lower education, a pattern confirmed across all models. Furthermore, income, health status, hospitalization history, physical exercise, and community environment also have significant effects on successful aging. However, factors such as residence, gender, and participation in pension insurance do not show a significant impact on successful aging.\u003c/p\u003e\n\u003cp\u003eTable3 Multivariate Logistic regression analysis on the association between education level and successful aging\u003c/p\u003e\n\u003cp\u003e3.4 Heterogeneity Analysis\u003c/p\u003e\n\u003cp\u003eThe results of the univariate analysis above show that there are significant differences in the levels of successful aging among elderly people in China with different educational backgrounds. The results of the multivariate logistic regression analysis indicate that education significantly affects successful aging in Chinese elderly people. Related research suggests that individual characteristics can influence successful aging. Therefore, the question arises: Does the effect of education on successful aging differ significantly across different groups of Chinese elderly? The following will conduct a heterogeneity analysis.\u003c/p\u003e\n\u003cp\u003eRegional Heterogeneity. As shown in Table 4, the effect of education on successful aging among rural elderly people is 0.387 (P \u0026lt; 0.05), indicating that education has a significant positive effect on successful aging in rural areas. For urban elderly people, the effect of education is 0.264 (P \u0026lt; 0.01), showing that education has a very significant positive effect on successful aging in urban areas. At the same time, the data also suggest that the promoting effect of education on successful aging is stronger in rural elderly people. This may be due to the relatively limited healthcare resources in rural China, where the improvement in health literacy brought about by education is more significant.\u003c/p\u003e\n\u003cp\u003eGender Heterogeneity. Similar to the regional heterogeneity, Table 4 shows that education has a very significant effect on the successful aging of both male and female elderly people in China. The effect of education on successful aging among male elderly is 0.228 (P \u0026lt; 0.01), indicating that education has a significant positive effect on successful aging in men. The effect of education on female elderly people is 0.354 (P \u0026lt; 0.01), showing that education has a stronger influence on the successful aging of women with higher significance.\u003c/p\u003e\n\u003cp\u003eAge Heterogeneity. As shown in Table 4, the effect of education on successful aging varies significantly across different age groups. For elderly people aged 60\u0026ndash;74, the effect of education is 0.302 (P \u0026lt; 0.01), indicating that education has a very significant positive effect on successful aging in this group. However, for elderly people aged 75 and above, the effect of education is not significant. This is likely due to the fact that at older ages, physical decline primarily dominates health, and the cognitive and social advantages brought by education diminish.\u003c/p\u003e\n\u003cp\u003eIncome Heterogeneity. Among low-income elderly people, the effect of education is 0.365 (P \u0026lt; 0.01), indicating that education has a very significant positive effect on successful aging in this group. However, for middle-income elderly people, the effect of education is not significant, suggesting that education does not have a significant impact on successful aging in this group. For high-income elderly people, the effect of education is 0.276 (P \u0026lt; 0.1), suggesting that education has a slight positive effect on successful aging in the high-income elderly group.\u003c/p\u003e\n\u003cp\u003eOverall, education has a positive and significant impact on successful aging in most elderly groups, with stronger effects in rural areas, among women, younger elderly, and low-income elderly people. However, for elderly people aged 75 and above and middle-income elderly, the effect of education on successful aging is not significant. For high-income elderly people, the effect of education on successful aging is weaker.\u003c/p\u003e\n\u003cp\u003eTable 4-1 Heterogeneity Analysis of the Impact of education level on successful aging Among older adults\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study finds that the level of successful aging among elderly individuals in China in 2020 was 15.15% (1391/9181), which is comparable to measurements made by other Chinese scholars in recent years [27]. Compared to the 14.41% success rate measured by You et al.[28]using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS), this figure shows a slight increase. However, compared to other countries, especially developed nations, the level of successful aging among elderly individuals in China remains relatively low. Nakagawa et al. [10]used national population sampling data from China, South Korea, and Japan to demonstrate differences in the levels of successful aging among elderly populations in these countries. The level of successful aging in China was found to be 15.7%, while in South Korea, it was 25.5%, and in Japan, it was 29.2%. It can be seen that the data from this study are close to the levels of successful aging among elderly individuals in China from the studies mentioned above. However, these studies were based on data from the Chinese elderly population in 2011, meaning that after nearly a decade, there has been little change in the successful aging level of elderly people in China, though there remains a significant gap compared to the levels observed in elderly individuals in Japan and South Korea 10 years ago. How can the differences in the levels of successful aging among the elderly in China, South Korea, and Japan be explained? Nakagawa [10]argues that, in addition to differences in healthcare systems and economic conditions, a key factor is the difference in education systems. Compared to the other two countries, China's compulsory education system was implemented later. China began nationwide compulsory education in 1986 and did not achieve universal nine-year education until 2011. According to the seventh national population census of China in 2020, the average years of education for the population aged 15 and above was 9.91 years [29]. The fifth China Urban and Rural Elderly Living Conditions Survey in 2021 shows that, among elderly people aged 60 and above, 61.0% have received education only up to elementary school or lower, 23.3% have completed middle school, 11.9% have completed high school (including technical schools and secondary vocational schools), and only 3.7% have a college education or higher. These figures align closely with those of the present study, indicating that the overall educational level of elderly individuals in China is currently quite low. It can be preliminarily concluded that the lower level of successful aging in China is strongly related to the relatively low educational attainment of the elderly population.\u003c/p\u003e\n\u003cp\u003eFurther analysis reveals that elderly individuals in China with lower educational levels are more likely to live in rural areas, be female, and have lower incomes. These characteristics reflect typical features of populations in developing countries. China's long-standing urban-rural dualism has led to a severe disparity in educational resources between rural and urban areas. Before 1980, rural populations generally had limited access to secondary or higher education, particularly women. The generations of elderly individuals in China (born between the 1950s and 1970s) grew up during a period of extreme scarcity in educational resources, with low levels of education in rural areas, where many women did not even complete elementary school. This resulted in a concentration of lower-educated elderly individuals in rural areas, while urban elderly people, who had access to better educational resources earlier, tend to have higher educational levels. Additionally, in China's traditional agricultural society, rural families prioritized the education of male children over female children, with women often assigned household or agricultural duties. The prevailing \"son preference\" led to systematic deprivation of educational opportunities for women. When rural households faced limited resources, male children were prioritized for education to take on family responsibilities, while women were married early or worked in agriculture, further widening the educational gender gap. These factors have contributed to a significant educational disparity between elderly women and men in China. Finally, there is a cyclical relationship between education level and income, as lower-educated individuals are more likely to engage in agriculture or manual labor, earning lower incomes and lacking social security. For example, rural pensions in China are only about one-tenth of those in urban areas [30]. Low-income families struggle to invest in the education of their descendants, creating a \"low education–low income\" vicious cycle. The fact that elderly individuals with low educational levels in China are more likely to live in rural areas, have a higher proportion of women, and a higher proportion of low-income individuals reflects the historically unequal distribution of educational opportunities, especially in rural and female populations. These factors combined result in lower-educated elderly individuals facing greater social and health challenges, which negatively affect their level of successful aging. This study shows that the level of successful aging among elderly individuals with low education is only 11.06%, far lower than that of individuals with middle education (20.20%) or high education (25.66%).\u003c/p\u003e\n\u003cp\u003eLooking specifically at several dimensions of successful aging, the study reveals that elderly individuals in China with higher educational levels perform better across all dimensions of successful aging. Elderly individuals with middle and high education levels are significantly more likely to be free of major chronic diseases, experience no functional loss, have normal cognitive function, be free of depression, and actively participate in social activities compared to those with lower education levels, especially in cognitive function, depression, and social participation.\u003c/p\u003e\n\u003cp\u003eRegarding chronic diseases and functional loss, according to the Social Determinants of Health Theory, an individual's health is not only influenced by biological and genetic factors but also by social, economic, and environmental factors. Education is considered one of the social determinants of health. Those with higher education levels typically have access to more resources, better social support, and more health information, which enables them to better prevent and manage diseases[1]. Multiple studies have shown that elderly individuals with lower education levels report poorer health[17] [18]and are more likely to suffer from chronic diseases, such as cardiovascular diseases, diabetes, and respiratory diseases[31][32]. Epidemiological surveys also indicate that elderly individuals with lower education levels are more likely to experience functional loss, with lower-educated elderly populations generally reporting more activity limitations and disabilities [33][20]. This study shows that among elderly individuals with higher education, 69.95% report no major chronic diseases, the highest proportion, while the lowest proportion of 64.87% is found among those with lower education. Additionally, 88.31% of elderly individuals with higher education report no functional loss, slightly lower than the 89.01% among those with middle education, while the lowest proportion (85.38%) is found among those with lower education. These findings indicate that elderly individuals with higher education levels fare better than those with lower education in terms of chronic diseases and functional loss.\u003c/p\u003e\n\u003cp\u003eIn terms of cognitive function, Alwin and McCammon[34]found that individuals born in different eras, due to variations in social education levels, had different opportunities and quality of education, which resulted in generational differences in cognitive abilities. People with higher education levels tend to have better cognitive reserves, which can delay cognitive decline, and they show milder symptoms even in the presence of pathological changes associated with aging (such as pre-Alzheimer's disease). Education promotes cognitive stimulation, enhancing higher-level cognitive skills like comprehension, reasoning, and memory, which are crucial for resisting cognitive deterioration in old age. This study finds that 29.90% of elderly individuals in China with lower education levels experience cognitive issues, significantly higher than those with middle (20.20%) or high (16.50%) education. This finding aligns with the results of Li et al.[35], further supporting the notion that education level positively influences cognitive abilities in the elderly.\u003c/p\u003e\n\u003cp\u003eIn terms of depression, this study shows that 47.77% of elderly individuals in China exhibit suspicious depressive symptoms, and 6.14% show clear signs of depression, figures similar to those found by Zhang et al.[27]. Numerous studies have found that education has a positive effect on mental health. Elderly individuals with higher education levels tend to have better knowledge and skills to regulate their negative emotions, leading to greater life satisfaction and better psychological health [21]. Ranchor et al. found that individuals' mental health varies according to their education level[36]. Liu et al. also found that elderly individuals with higher education levels are better at self-regulating to reduce loneliness, thereby achieving better mental health[37]. This study finds that 58.71% of elderly individuals with lower education levels experience depression, far higher than the 49.07% of those with middle education and 39.27% of those with high education. Thus, education plays an active role in reducing depressive symptoms, with elderly individuals with higher education levels being less likely to experience depression and more likely to achieve successful aging.\u003c/p\u003e\n\u003cp\u003eIn terms of social participation, this study found that the proportion of Chinese elderly with low education levels actively participating in social activities was 42.81%, which is significantly lower than the proportion for those with medium education (58.15%) and high education (64.29%). This finding is consistent with the research by Peng et al. [38], which examined the relationship between the education levels of middle-aged and elderly Chinese residents and the occurrence of disability. Their study found that the participation rate in social activities was lower among the illiterate elderly compared to the literate elderly. Moreover, illiterate individuals were at a higher risk of experiencing disability than their literate counterparts. Other studies have shown that middle-aged and elderly individuals who are \"female,\" \"urban residents,\" \"higher income,\" and \"higher education\" are more likely to engage in social activities [39]. Educated individuals are more inclined to participate in social activities, and education level is a key factor in determining the likelihood of disability, primarily through its influence on social participation[38]. Therefore, education influences the probability of elderly individuals participating in social activities, and participation in social activities is associated with both their psychological health and physical disability. Chinese elderly individuals with higher education levels are more likely to engage in social activities, which in turn increases the likelihood of successful aging.\u003c/p\u003e\n\u003cp\u003eOverall, elderly Chinese individuals with higher education levels perform better across various aspects of successful aging, including the presence of major chronic diseases, functional loss, cognitive function, depressive symptoms, and social participation, compared to those with lower education levels. These differences highlight the critical role that education plays in the health and successful aging of the elderly. Elderly individuals with higher education not only perform better in terms of physical health (such as chronic diseases and functional loss), but they also exhibit more positive outcomes in mental health (such as depression) and social activity participation.\u003c/p\u003e\n\u003cp\u003eHealth behaviors are influenced not only by individual factors but also by the interaction of social, environmental, and cultural factors[26]. Similarly, the aging status of the elderly can be seen as being influenced by multiple variables, including personal, family, community, and policy factors. This study shows that education is an important and stable predictor of successful aging, with its effects partially mediated by health behaviors, economic resources, and the community environment. Firstly, education not only improves elderly individuals’health behaviors but also enhances their knowledge and management of health, which is crucial for successful aging. Secondly, education interacts with other factors such as income and health status, collectively influencing successful aging. Higher income and better health can amplify the positive effects of education, making it easier for elderly individuals to enjoy a high-quality later life. Lastly, community environment, health behaviors, and social security policies positively influence successful aging for elderly individuals with higher education levels. Those with higher education are more likely to participate in community activities and access social security resources, thus increasing their social support and sense of participation, which contributes to successful aging.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn summary, the level of successful aging among Chinese elderly individuals is relatively low, with significant differences in successful aging levels across different education groups. Overall, education has a positive impact on successful aging among the elderly in China. Higher education levels are generally associated with better health, stronger social adaptability, and greater social resources, all of which contribute to improving the quality of life and mental health of elderly individuals. These factors help alleviate the health, economic, and social isolation challenges faced by the elderly, enabling them to better adapt to the aging process. Education is a key factor in enhancing successful aging, with its impact being particularly pronounced for rural elderly, women, younger elderly individuals, and those with lower incomes.\u003c/p\u003e\n\u003cp\u003eIn the future, as population aging accelerates in developing countries such as China, the impact of education on successful aging among the elderly in these countries will become increasingly important. Strengthening elderly education and lifelong learning systems, as well as promoting social awareness and support for education in later life, will help mitigate the social and economic challenges brought by aging and contribute to the holistic development and well-being of the elderly population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eCLASS=China Longitudinal Aging Social Survey\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWHO = World Health Organization\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eUN = United Nations\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eADLs=Activities of daily living\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSDH=Social Determinants of Health\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMMSE=Mini-Mental State Examination\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCES-D=Center for Epidemiologic Studies Depression Scale\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eORs=odds ratios\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCIs=confidence intervals\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCHARLS=China Health and Retirement Longitudinal Study\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSTATS=National Bureau of Statistics\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMOHRSS=Ministry of Human Resources and Social Security\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChina Longitudinal Aging Social Survey (CLASS)was conducted with the approval of the Ethical Review Committee of Renmin University of China. The survey data remained anonymous, and participants’\u0026nbsp;responses were protected under privacy law.Additionally, each participant provided signed informed consent in accordance with the Helsinki Declaration at the time of participation. As the survey was already ethically approved, there was no need for further ethics approval for those using the data as authorized users.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CLASS datasets are publicly available at Renmin University of China Open Research Data platform (http://cgss.ruc.edu.cn/). Researchers can obtain these data after submitting a data use agreement to the CLASS team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo Funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHG conceived and designed the research, provided guidance throughout the entire research process, and responsible for all R\u0026amp;R works. QT and YG participated in data analysis, wrote and supplemented the English paper. HH reviewed and edited the paper. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank the participants of this study and the date providers of\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChina Longitudinal Aging Social Survey (CLASS).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWHO. (2025). \u003cem\u003ePopulation Ageing\u003c/em\u003e. Available at: https://www.who.int/en/news-room/questions-and-answers/item/population-ageing.\u003c/li\u003e\n \u003cli\u003eUN.(2025).\u003cem\u003eWorld Population Prospects 2024\u003c/em\u003e. Available at: https://www.un.org/development/desa/pd/world-population-prospects-2024\u003c/li\u003e\n \u003cli\u003eZheng, B. W. (2025). \u003cem\u003eThe Situation and Trends of Global Population Ageing: International Comparisons of Response Measures and Key Insights\u003c/em\u003e. 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Nursing Science, 12(4), 597-604.\u003c/li\u003e\n \u003cli\u003eRanchor A V，Bouma J，Sanderman R.(1996). \u003cem\u003eVulnerability and social class\u003c/em\u003e\u003cem\u003e：\u003c/em\u003e\u003cem\u003eDifferential patterns of personality and social support over the social classes\u003c/em\u003e. Personality and Individual Differences. 20(2):229\u0026minus;237.\u003c/li\u003e\n \u003cli\u003eLiu, J., Xu, H., \u0026amp; Song, S. (2009). \u003cem\u003eThe Relationship Between Loneliness in Older Adults and Parental Support and Filial Piety Expectations\u003c/em\u003e. Chinese Journal of Clinical Psychology, (5), 636-638.\u003c/li\u003e\n \u003cli\u003ePeng, S., Fu, X., \u0026amp; Feng, X. (2021). \u003cem\u003eEducation Level and Disability Occurrence Among Middle-Aged and Elderly Chinese Residents: The Mediating Role of Social Participation\u003c/em\u003e. Peking University Medical Journal, 53(3), 549-554. doi:10.19723/j.issn.1671-167X.2021.03.018.\u003c/li\u003e\n \u003cli\u003eFeng Z, Cramm JM, Jin c, et al.(2020). \u003cem\u003eThe longitudinal relationship between income and social participation among chinese older people\u003c/em\u003e. SSM Popul Health.11:100636. doi: 10.1016/j.ssmph.2020.100636\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Elderly, Successful Aging, Education, China, Impact Factor Analysis","lastPublishedDoi":"10.21203/rs.3.rs-6798552/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6798552/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study uses data from the 2020 China Longitudinal Aging Social Survey (CLASS) to analyze the status of successful aging among Chinese elderly individuals and the impact of education on successful aging. It explores the characteristics of China's aging process and the effects of education, providing a basis for formulating appropriate aging policies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe study included 9,181 participants, with 5,730 (62.41%) elderly individuals with low education, 2,356 (25.66%) with medium education, and 1,095 (11.93%) with high education. Descriptive statistical analysis was first conducted to compare the demographic characteristics of elderly individuals with different education levels. The study then described the levels of successful aging and the status of the five measurement dimensions for each group, using χ² tests for differences. Subsequently, multi-factor logistic regression was employed to analyze the effects of education, controlling for demographic variables, health status and behavioral variables, and family, community, and policy variables. Finally, based on the previous analysis, heterogeneity analysis was performed to examine the impact of education on successful aging across different regions, genders, ages, and income levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe overall level of successful aging among the elderly was 15.15% (1,391/9,181). The successful aging levels for elderly individuals with low, medium, and high education were 11.06%, 20.20%, and 25.66%, respectively (P \u0026lt; 0.01). Elderly individuals with higher education levels performed better than those with lower education in terms of chronic diseases, functional loss, cognitive function, depression symptoms, and social activity participation (P \u0026lt; 0.01). Multi-factor logistic regression results showed that, after controlling for demographic variables, elderly individuals with medium and high education had successful aging levels 1.581 times (OR=1.581, 95% CI=1.299-1.924) and 2.086 times (OR=2.086, 95% CI=1.677-2.595) higher, respectively, than those with low education. After further controlling for health status and behavioral variables, elderly individuals with medium and high education had successful aging levels 1.480 times (OR=1.480, 95% CI=1.210-1.811) and 1.818 times (OR=1.818, 95% CI=1.450-2.281) higher, respectively. After controlling for family, community, and policy variables, elderly individuals with medium and high education had successful aging levels 1.462 times (OR=1.462, 95% CI=1.192-1.794) and 1.767 times (OR=1.767, 95% CI=1.401-2.229) higher, respectively. Heterogeneity analysis revealed that education had a positive and significant impact on successful aging in most elderly groups, with stronger effects for rural residents, females, younger elderly individuals, and those with low income (P \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study shows that the level of successful aging among Chinese elderly is relatively low, and there are significant differences in successful aging levels across elderly groups with different education levels. Overall, education has a positive impact on successful aging among Chinese elderly individuals. Education is a critical factor in improving successful aging, especially for rural, female, younger, and low-income elderly individuals. By incorporating the Chinese experience, this research seeks to enrich the cross-cultural applicability of existing successful aging theories, provide empirical evidence to inform aging policies in developing countries\u003c/p\u003e","manuscriptTitle":"Education and Successful Aging Among Chinese Elderly: Insights from CLASS Data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-13 13:29:36","doi":"10.21203/rs.3.rs-6798552/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4d6a6b87-d72c-4287-9a79-6bf3e2fb52d0","owner":[],"postedDate":"June 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-17T03:53:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-13 13:29:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6798552","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6798552","identity":"rs-6798552","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}