Educational inequalities in adult mortality: a systematic review and meta-analysis of the Asia Pacific region
Talal Mohammad,
Magnus Rom Jensen,
Emmanuela Gakidou,
Terje Andreas Eikemo,
Kathryn Christine Beck,
Mirza Balaj,
Lorena Donadello,
Hanne Dahl Vonen,
Claire Degail,
Kristoffer Eikemo,
Anna Giouleka,
Indrit Gradeci,
Celine Westby,
Kam Sripada,
Solvor Solhaug
Affiliations
Talal Mohammad
3 Department of Public Health and Nursing / CHAIN, NTNU, Trondheim, Norway
Magnus Rom Jensen
6 Dragvoll library, NTNU, Trondheim, Norway
Emmanuela Gakidou
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
Terje Andreas Eikemo
Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
Kathryn Christine Beck
Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
Mirza Balaj
Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
Lorena Donadello
Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
Hanne Dahl Vonen
Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
Claire Degail
Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
Kristoffer Eikemo
Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
Anna Giouleka
Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
Indrit Gradeci
Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
Celine Westby
Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
Kam Sripada
Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
Solvor Solhaug
Library Section for Humanities, Education and Social Sciences, University Library, Norwegian University of Science and Technology, Trondheim, Norway
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.
