The association between educational level and multimorbidity among adults in Southeast Asia: A systematic review

Abstract

Background In Southeast Asia, the prevalence of multimorbidity is gradually increasing. This paper aimed to investigate the association between educational level and multimorbidity among over 15-years old adults in Southeast Asia. Methods We conducted a systematic review of published observational studies. Studies were selected according to eligibility criteria of addressing definition and prevalence of multimorbidity and associations between level of education and multimorbidity in Southeast Asia. The Newcastle-Ottawa Scale (NOS) was used to measure the quality and risk of bias. The methodology has been published in PROSPERO with registered number ID: CRD42021259311. Results Eighteen studies were included in the data synthesis. The results are presented using narrative synthesis due to the heterogeneity of differences in exposures, outcomes, and methodology. The prevalence of multimorbidity ranged from 1.7% to 72.6% among over 18 years-old adults and from 1.5% to 51.5% among older people (≥ 60 years). There were three association patterns linking between multimorbidity and education in these studies: (1) higher education reducing odds of multimorbidity, (2) higher education increasing odds of multimorbidity and (3) education having no association with multimorbidity. The association between educational attainment and multimorbidity also varies widely across countries. In Singapore, three cross-sectional studies showed that education had no association with multimorbidity among adults. However, in Indonesia, four cross-sectional studies found higher educated persons to have higher odds of multimorbidity among over 40-years-old persons. Conclusions Published studies have shown inconsistent associations between education and multimorbidity because of different national contexts and the lack of relevant research in the region concerned. Enhancing objective data collection such as physical examinations would be necessary for studies of the connection between multimorbidity and education. It can be hypothesised that more empirical research would reveal that a sound educational system can help people prevent multimorbidity.

Sociodemographic Differences in Multimorbidity: A Closer Look from Indonesian Family and Life Survey

“…However, the researchers also found that the prevalence increased in people with university/college degrees. It aligns with a review study in Indonesia that multimorbidity cases would increase along with their education level [4].…”

“…Lowand middle-income countries (LMICs) were estimated to have a multimorbidity prevalence of 10-11%, which is predicted to increase in the coming years. The prevalence of multimorbidity in Southeast Asia also gradually increases from 4.5% at the beginning of the 21st century to about 10% in recent years [4]. In addition, the prevalence of multimorbidity, the coexistence of two or more chronic diseases, is expected to increase, including in Indonesia.…”

“…Socioeconomic status (SES) inequalities may be reflected in unequal access to health care, participation in health activities, and life stressors, contributing to the increased burden of multiple chronic conditions. Furthermore, lower socioeconomic groups who suffer from multimorbidity will suffer more since they have limited access to diagnosis and the burden of expensive treatment [4].…”

One in five South Africans are multimorbid: An analysis of the 2016 demographic and health survey

“…The present study showed that having tertiary education decreased the odds of multimorbidity, this has been noted both locally and internationally [ 19 , 20 , 52 ]. However, a systematic review of education levels and multimorbidity in Southeast Asia found the association was inconsistent [ 53 ]. This study found that being employed decreased the odds of multimorbidity.…”

Changes in Prevalence and Determinants of Self-Reported Hypertension among Bangladeshi Older Adults during the COVID-19 Pandemic

“…Evidence suggests that increased fear and anxiety are connected to high blood pressure [ 54 , 55 ]. A recent systematic review of 18 studies conducted in Southeast Asia reported mixed associations between education and chronic diseases related to multimorbidity [ 56 ]. Considering such fluctuating evidence, further studies are required to better understand the association between educational status and the prevalence of hypertension.…”