Education Level, Monthly Per-Capita Expenditure, and Healthy Aging in the Older Indonesian Population: The Indonesia Family Life Survey 2007 and 2014

Education Level, Monthly Per-Capita Expenditure, and Healthy Aging in the Older Indonesian Population: The Indonesia Family Life Survey 2007 and 2014

DIETA NURRIKA,^1,2 SHU ZHANG,¹ ANDREA DISCACCIATI,³ YASUTAKE TOMATA,¹ YINGXU LIU,¹ YUMI SUGAWARA¹ and ICHIRO TSUJI¹

¹Division of Epidemiology, Department of Health Informatics and Public Health, School of Public Health, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
²Banten School of Health Science, Ministry of Research, Technology and Higher Education, Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung, West Java, Indonesia
³Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Stockholm, Sweden

In developed countries, the relationship between education level, wealth, and healthy aging have been found to be mediated by modifiable risk factors, such as obesity, physical activities, and smoking status. The present study was to investigate the association between education level, monthly per-capita expenditure (PCE), and healthy aging in the older Indonesian population, and to clarify modifiable risk factors that mediate this association. A 7-year prospective longitudinal study (2007-2014) was conducted on 696 older Indonesian individuals (ge; 50 years) living in 13 different provinces in Indonesia during the survey periods. Data on educational level, PCE, and modifiable risk factors were collected in 2007. Information on healthy aging was obtained in both 2007 and 2014. A multivariate-adjusted logistic regression model was used to estimate the odds ratio (ORs) and 95% confidence intervals (CIs) for healthy aging by education level and PCE. The mediating effects were estimated using a four-way effect decomposition. Out of 696 eligible subjects, 206 (29.6%) were judged as healthy aging in 2014. The OR (95% CI) for healthy aging for participants with a higher education level was 1.81 (1.23-2.65) compared with those with a lower education level, and no significant association was observed between PCE and healthy aging. An association was thus observed between education level and healthy aging, but not PCE. Importantly, the association between education level, PCE, and healthy aging does not appear to be mediated by the modifiable risk factors. Priorities in making health policy would be different between developed countries and developing countries.

Keywords —— education level; healthy aging; Indonesia; mediation analysis; monthly per-capita expenditure

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Tohoku J. Exp. Med., 2020, 250, 95-108

Correspondence: Ichiro Tsuji, Division of Epidemiology, Department of Health Informatics and Public Health, School of Public Health, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.

e-mail: tsuji1@med.tohoku.ac.jp