Educational inequalities in adult mortality: a systematic review and meta-analysis of the Asia Pacific region

Kathryn Christine Beck; Mirza Balaj; Lorena Donadello; Talal Mohammad; Hanne Dahl Vonen; Claire Degail; Kristoffer Eikemo; Anna Giouleka; Indrit Gradeci; Celine Westby; Kam Sripada; Magnus Rom Jensen; Solvor Solhaug; Emmanuela Gakidou; Terje Andreas Eikemo

doi:10.1136/bmjopen-2021-059042

Educational inequalities in adult mortality: a systematic review and meta-analysis of the Asia Pacific region

BMJ Open. 2022 Aug 8;12(8):e059042. doi: 10.1136/bmjopen-2021-059042.

Authors

Kathryn Christine Beck^{1

2}, Mirza Balaj², Lorena Donadello², Talal Mohammad², Hanne Dahl Vonen², Claire Degail², Kristoffer Eikemo², Anna Giouleka², Indrit Gradeci², Celine Westby², Kam Sripada^{2

3}, Magnus Rom Jensen⁴, Solvor Solhaug⁴, Emmanuela Gakidou^{5

6}, Terje Andreas Eikemo²

Affiliations

¹ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway kathryb@stud.ntnu.no.
² Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway.
³ Centre for Digital Life Norway, Norwegian University of Science and Technology, Trondheim, Norway.
⁴ Library Section for Humanities, Education and Social Sciences, University Library, Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
⁶ Department of Health Metrics Sciences, School of Medicine, University of Washington Seattle Campus, Seattle, Washington, USA.

Abstract

Objectives: In this study, we aim to analyse the relationship between educational attainment and all-cause mortality of adults in the high-income Asia Pacific region.

Design: This study is a comprehensive systematic review and meta-analysis with no language restrictions on searches. Included articles were assessed for study quality and risk of bias using the Joanna Briggs Institute critical appraisal checklists. A random-effects meta-analysis was conducted to evaluate the overall effect of individual level educational attainment on all-cause mortality.

Setting: The high-income Asia Pacific Region consisting of Japan, South Korea, Singapore and Brunei Darussalam.

Participants: Articles reporting adult all-cause mortality by individual-level education were obtained through searches conducted from 25 November 2019 to 6 December 2019 of the following databases: PubMed, Web of Science, Scopus, EMBASE, Global Health (CAB), EconLit and Sociology Source Ultimate.

Primary and secondary outcome measures: Adult all-cause mortality was the primary outcome of interest.

Results: Literature searches resulted in 15 345 sources screened for inclusion. A total of 30 articles meeting inclusion criteria with data from the region were included for this review. Individual-level data from 7 studies covering 222 241 individuals were included in the meta-analyses. Results from the meta-analyses showed an overall risk ratio of 2.40 (95% CI 1.74 to 3.31) for primary education and an estimate of 1.29 (95% CI 1.08 to 1.54) for secondary education compared with tertiary education.

Conclusion: The results indicate that lower educational attainment is associated with an increase in the risk of all-cause mortality for adults in the high-income Asia Pacific region. This study offers empirical support for the development of policies to reduce health disparities across the educational gradient and universal access to all levels of education.

Prospero registration number: CRD42020183923.

Keywords: EPIDEMIOLOGY; PUBLIC HEALTH; SOCIAL MEDICINE.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Asia / epidemiology
Health Inequities*
Humans
Japan
Mortality*
Republic of Korea
Singapore