Education shapes not just average healthy lifespan but its full distribution in Europe

Most research on educational inequalities in healthy life expectancy has focused on average differences between groups. A new study published in the journal Genus takes a different approach, examining how healthy longevity is distributed within educational groups rather than only comparing group means.

The study, authored by Rami Cosulich and Virginia Zarulli, examined sex-specific educational differences in healthy longevity distributions at age 60 in Europe. It used multiple health measures to define the end of the healthy lifespan, rather than relying on a single definition of health.

The researchers combined data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with Eurostat life expectancy data covering 2016 and 2017. To estimate distributions of age at the end of healthy lifespan, they applied a Markov chain model combined with the maximum entropy method.

Two formal comparison tools were used to assess differences between educational groups: the healthy lifespan outsurvival statistic, which quantifies the probability that one person outlives another in healthy years, and the Hellinger distance, a measure of how far apart two distributions are.

The results showed that high education was often associated with more negatively skewed healthy longevity distributions. In practical terms, this means that among the highly educated, healthy lifespans were more compressed toward the higher end of the range, with fewer individuals experiencing very short healthy lifespans.

Men with low education had higher healthy lifespan variation than men with high education. This suggests that among less-educated men, outcomes were more dispersed, with some individuals experiencing considerably shorter healthy lifespans than others in the same educational group.

Across all health measures for women, and most health measures for men, the probability that a person with low education had a longer healthy lifespan than a person of the same sex with high education was below 50 percent. However, the study notes that a lack of statistical significance meant this finding did not apply to men for life free from cardiovascular conditions or for a broad range of chronic conditions.

The authors argue that moving beyond average values and adopting a distributional perspective highlights dimensions of health inequality that mean-based measures such as healthy life expectancy alone cannot capture. Two groups with the same average healthy life expectancy could still differ substantially in how uncertain or unequal healthy longevity is within each group.

The study also points to the need for further methodological development in the estimation of healthy longevity distributions, indicating that the authors view the current approach as a step in an ongoing research agenda rather than a final word. The analysis was based on data from 2016 and 2017, and the findings concern European populations aged 60 and over as captured by the SHARE survey.

Subject of Research: Educational differences in the distribution of healthy longevity at age 60 in Europe

Article Title: Beyond healthy life expectancy: educational differences in healthy longevity distributions in Europe

Article References: Cosulich, R., & Zarulli, V. (2026). Beyond healthy life expectancy: educational differences in healthy longevity distributions in Europe. Genus. https://doi.org/10.1186/s41118-026-00301-7

Image Credits: AI Generated

DOI: 10.1186/s41118-026-00301-7

Keywords: healthy life expectancy, education, healthy longevity, SHARE, Europe, ageing, health inequality, Markov chain model, life expectancy, older adults, Beyond, healthy