We examine the health-education gradient in the 2000s among older adults in the United States, Canada, France, the Netherlands, Spain and Italy. Using longitudinal survey data, we assess how incidence rates of poor health, of difficulties with activities of daily living, and of chronic conditions vary by educational attainment across countries. We also examine how potential confounders – demographic characteristics, income, health care use and health behaviours – affect the health-education gradient within countries over time. We find systematic differences in disease incidence, as well as in the health-education gradients, across countries. We also demonstrate that while adjusting for confounders generally diminishes the health-education gradient, the impacts of these variables vary somewhat across countries.