Educational inequalities in self-rated health and their mediators in late adulthood: Comparison of China and Japan

• Published in: PloS one 2023-09, Vol.18 (9), p.e0291661-e0291661
• Main Authors: Ping, Ruru, Oshio, Takashi
• Format: Article
• Language: English
• Subjects: Adults; Aging; Analysis; Community colleges; Confidence intervals; Education; Educational attainment; Ethics; Evaluation; Exercise; Family income; Geriatrics; Health behavior; Health care disparities; Households; Illiteracy; Likert scale; Longitudinal studies; Mediation; Medicine and Health Sciences; Middle schools; Older people; People and Places; Physical activity; Polls & surveys; Population studies; Regression analysis; Regression models; Response rates; Secondary schools; Self-care, Health; Social Sciences; Socioeconomic factors; Statistical analysis; Surveys; Variables
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0291661

Education has an impact on health, but the magnitude of the impact may vary across countries. This cross-sectional study compared educational inequalities in health and their mediators in late adulthood between China and Japan, which both face rapid population aging. We studied the same age cohort (63-72 years) based on two nationwide population-based surveys in 2018: the China Health and Retirement Longitudinal Study (N = 5,277) and Japan's Longitudinal Survey of Middle-Age and Elderly Persons (N = 20,001). The relative index of inequality (RII) in education was used to measure educational inequality in self-rated health (SRH). We then examined the extent to which income, smoking, leisure-time physical activity, and social participation mediated educational inequalities in SRH. In both countries, a lower educational level was associated with a higher risk of poor SRH; in China, however, the gradient was flatter. In China, the RII of education was 1.69 (95% confidence interval [CI]: 1.20-2.39) for men and 1.47 (95% CI: 1.06-2.05) for women. In Japan, meanwhile, RII was 2.70 (95% CI: 2.21-3.28) for men and 2.60 (95% CI: 2.13-3.18) for women. Our mediation analysis based on logistic regression models with bootstrapping also found that social participation was a key mediator of educational inequalities in health in both countries. In all, the results underscore that one's relative position in educational inequalities is a reliable predictor of subjective health in late adulthood in both China and Japan.