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

• Published in: PloS one Vol. 16; no. 12; p. e0261584
• Main Authors: Feng, Xiyu, Kelly, Matthew, Sarma, Haribondhu
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20.12.2021; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Adults; Age Factors; Asia, Southeastern - epidemiology; Chronic illnesses; Comorbidity; Cross-sectional studies; Data collection; Diabetes; Economic development; Education; Education, Higher; Educational aspects; Educational attainment; Educational Status; Global health; Health aspects; Heterogeneity; Humans; Hypertension; Medicine and Health Sciences; Multimorbidity; Older people; People and Places; Physical examinations; Research and Analysis Methods; Risk factors; Social Sciences; Socioeconomic factors; Synthesis; Systematic review; Young Adult; Asia, Southeastern; Southeast Asia; Singapore; Myanmar (Burma); Cambodia; Philippines; Canberra Australian Capital Territory Australia; Timor-Leste; Malaysia; Thailand; Brunei; Vietnam; Australia; Laos; Indonesia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0261584

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. 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. 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. 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.