In a recent study published in The Lancet Public Health, researchers investigated the impact of education on overall mortality risk in adults on a global scale.
Study: The Impact of Education on Adult Mortality: A Global Systematic Review and Meta-Analysis. Image Source: Drazen Zigic/Shutterstock.com
There is a connection between higher education and better health; However, studies have not estimated the extent of this relationship on a global scale.
Besides technological advancements, access to quality healthcare, clean water and sanitation, and labor rights, education is one of the most important health determinants. Additionally, education promotes socio-economic empowerment for all genders.
The UN Sustainable Development Goals (SDGs) 4.1 and 4.3 particularly uphold primary and secondary education for children and tertiary education for adults.
It has been shown that adult education, especially maternal education, reduces child mortality by 3% for children aged ≤ 5 years and parental education by 1.6%.
About the Study
The researchers thoroughly searched seven databases, including Web of Science, PubMed, and Scopus, to identify all research publications that assessed overall mortality as an outcome and years of schooling as an independent variable. They retrieved all papers from January 1, 1980, to June 16, 2023.
Two reviewer teams then assessed these studies for individual-level education and mortality data.
A person extracted data into a standard template derived from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD).
Next, they implemented mixed-effects meta-regression models to account for heterogeneity between studies by adjusting for study-level covariates, including age, gender, and marital status, and reported estimation uncertainties. They also created funnel plots to assess publication or reporting biases.
This systematic review was the most comprehensive qualitative synthesis of articles with individual-level data not limited to a single country or time period; Moreover, it surpassed the scope of previous research on education level and mortality.
The authors identified 17,094 unique works, of which 603 met the inclusion criteria for analysis. These papers encompassed 10,355 observations from 59 countries.
The observed relationship between adult overall mortality and education was dose-dependent, with an average reduction in the mortality risk of 1.9% per additional year of schooling.
On average, an adult with 12 years of schooling had a 24.5% lower mortality risk than an adult who never attended school.
This effect was more pronounced in younger individuals than in older adults. Accordingly, the average reduction in mortality risk associated with an additional year of education for adults aged 18 to 49 and over 70 years was 2.9% and 0.8%, respectively.
However, educational inequalities in mortality persisted across the lifespan, and this pattern remained consistent across all birth cohorts and periods.
The protective effect of education level on adult overall mortality did not vary by gender or socioeconomic index level; However, this observation requires further investigation.
On the other hand, the effects of education on mortality risk are comparable to those of other social determinants with significant impact, emphasizing the benefits of increased investment in education for future population health.
For example, the overall mortality risk for an adult without education compared to an adult with 12 years of education is similar to that of a current smoker (5 pack-years) compared to a non-smoker (RR ~1.52), highlighting the crucial importance of improved and equitable education levels as a global health goal.
This study complements the limited scientific literature on unequal overall adult mortality worldwide and reinforces previous evidence that low education is a risk factor for adult mortality.
In this study, the protective effect of higher education on mortality was stable and did not weaken in economic context, with increasing age, gender, or over time. Therefore, increasing the number of years of education can help counteract the growing disparities in adult mortality rates.
Continued investment in educational institutions worldwide is the need of the hour and should be viewed as an investment in future public health.