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Cited by 192Health disparities and outcomesInsurance, Mortality, Demography, Risk ManagementIntergenerational and Educational Inequality Studies

Effects of education on adult mortality: A global systematic review and meta-analysis

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Balaj, Mirza, Henson, Claire A., Aronsson, Amanda, Aravkin, Aleksandr, Beck, Kathryn, Degail, Claire, Donadello, Lorena, Eikemo, Kristoffer +18 more·2024·The Lancet Public Health
DOI 10.1016/s2468-2667(23)00306-7PMC PMC10901745
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Abstract

BACKGROUND: The positive effect of education on reducing all-cause adult mortality is known; however, the relative magnitude of this effect has not been systematically quantified. The aim of our study was to estimate the reduction in all-cause adult mortality associated with each year of schooling at a global level. METHODS: In this systematic review and meta-analysis, we assessed the effect of education on all-cause adult mortality. We searched PubMed, Web of Science, Scopus, Embase, Global Health (CAB), EconLit, and Sociology Source Ultimate databases from Jan 1, 1980, to May 31, 2023. Reviewers (LD, TM, HDV, CW, IG, AG, CD, DS, KB, KE, and AA) assessed each record for individual-level data on educational attainment and mortality. Data were extracted by a single reviewer into a standard template from the Global Burden of Diseases, Injuries, and Risk Factors Study. We excluded studies that relied on case-crossover or ecological study designs to reduce the risk of bias from unlinked data and studies that did not report key measures of interest (all-cause adult mortality). Mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among studies and to adjust for study-level covariates. This study was registered with PROSPERO (CRD42020183923). FINDINGS: 17 094 unique records were identified, 603 of which were eligible for analysis and included data from 70 locations in 59 countries, producing a final dataset of 10 355 observations. Education showed a dose-response relationship with all-cause adult mortality, with an average reduction in mortality risk of 1·9% (95% uncertainty interval 1·8-2·0) per additional year of education. The effect was greater in younger age groups than in older age groups, with an average reduction in mortality risk of 2·9% (2·8-3·0) associated with each additional year of education for adults aged 18-49 years, compared with a 0·8% (0·6-1·0) reduction for adults older than 70 years. We found no differential effect of education on all-cause mortality by sex or Socio-demographic Index level. We identified publication bias (p<0·0001) and identified and reported estimates of between-study heterogeneity. INTERPRETATION: To our knowledge, this is the first systematic review and meta-analysis to quantify the importance of years of schooling in reducing adult mortality, the benefits of which extend into older age and are substantial across sexes and economic contexts. This work provides compelling evidence of the importance of education in improving life expectancy and supports calls for increased investment in education as a crucial pathway for reducing global inequities in mortality. FUNDING: Research Council of Norway and the Bill & Melinda Gates Foundation.

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  • A 2024 global systematic study reported that educational attainment was associated with a 1.9% reduction in all-cause adult mortality.

    “Similarly, a 2024 global systematic study reported that educational attainment was associated with a 1.9% reduction in all-cause adult mortality [54].”

    From Then, Now, Next: Unpacking the Shifting Trajectory of Social Determinants of Health (2025) · cites this paper as [54]

    The Results report a 1.9% average reduction in adult all-cause mortality risk, but specify that this is per additional year of education. The citing sentence omits that essential qualifier, making the magnitude appear to apply to educational attainment generally. (LLM, conf=0.86)

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  • Estimates suggest that 12 years of schooling reduces the risk of mortality in adulthood by 25%, or almost two percent for each additional year of education.

    “Estimates suggest that 12 years of schooling reduces the risk of mortality in adulthood by 25%, or almost two percent for each additional year of education.111”

    From Global health 2050: the path to halving premature death by mid-century (2024) · cites this paper as [111]

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References 52 · Cited by 192

Research works printed but not linked: 38

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Authors
Balaj, M., Henson, C. A., Aronsson, A., Aravkin, A., Beck, K., Degail, C., Donadello, L., Eikemo, K., Friedman, J., Giouleka, A., Gradeci, I., Hay, S. I., Jensen, M. R., Mclaughlin, S. A., Mullany, E. C., O'connell, E. M., Sripada, K., Stonkute, D., Sorensen, R. J. D., Solhaug, S., Vonen, H. D., Westby, C., Zheng, P., Mohammad, T., Eikemo, T. A., & Gakidou, E.
ORCID
Venue
The Lancet Public Health
Publisher
Elsevier BV
Published
2024-03
Volume
9
Issue
3
Pages
e155-e165
ISSN
2468-2667 (ISSN-L)
DOI
10.1016/s2468-2667(23)00306-7
PMC
PMC10901745
OpenAlex
W4391127471
Cited by
192
References
52
Citations by year
2026: 66 · 2025: 88 · 2024: 38
FWCI
18.36
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders
  • Norges Forskningsråd (288638)
  • Bill and Melinda Gates Foundation (GR016994)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
  • Social Sciences › Sociology and Political Science › Intergenerational and Educational Inequality Studies
Keywords
education, educational attainment, all-cause mortality, adult mortality, years of schooling, dose-response relationship, age differences in mortality, sex differences, socioeconomic status, mortality risk reduction, global health burden, publication bias, microdata
MeSH terms
Adult, Aged, Educational Status, Humans, Life Expectancy, Mortality, Norway, Databases, Factual

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