Midlife in crisis? Life course pathways to health at midlife across U.S. cohorts

Recent trends of increasing midlife morbidity and mortality and widening educational disparities in the United States are concerning. This study documented the age pattern and educational disparities in health in the National Longitudinal Study of Adolescent to Adult Health (Add Health) cohort as they enter midlife, and situates the cohort relative to preceding, similar, and following cohorts in the National Health and Nutrition Examination Survey (NHANES).

Using data from Add Health and NHANES on 6 birth cohorts observed from adolescence to middle age, we characterized age patterns in general health, mental health, health behaviors, and chronic conditions within and across cohorts. We documented disparities by educational attainment, focusing on those with and without a 4-year college degree, and how such disparities emerge and evolve across the life course.

Analysis showed that general health, mental health, and chronic disease deteriorated for the Add Health cohort as they aged into midlife, while health behaviors improved. Compared to the NHANES cohorts, the Add Health cohort had worse health than older cohorts, generally worse health compared to the same birth cohort, with some exceptions, and mixed health compared to younger cohorts. Educational gradients were relatively stable across age, with some evidence of increases, while educational gradients generally increased across cohorts.

The worsening health of the Add Health cohort with age and relative to previous cohorts has important implications for aging, as this currently midlife cohort of U.S. adults will enter old age in worse health than their predecessors.