Drivers of health inequalities across education level among older Filipinos: a decomposition analysis using nationwide survey data

Background: Although the socioeconomic gradients of health are widely documented, little is known about the extent and drivers of education-related inequalities in health status among older adults in the Philippines, a lower-middle income country transitioning to an ageing society. This is the first study to decompose the contribution of social determinants of health (SDH) to inequalities in health among lower- and higher-educated older Filipinos. 

Methods: Using nationally representative survey data on 5,209 Filipinos aged 60 + from the 2019 Longitudinal Study of Ageing and Health in the Philippines, Oaxaca-Blinder decomposition analysis is performed based on linear models of self-rated health, functional limitation, and depressive symptoms. 

Results: There are substantial gaps in older Filipinos’ health outcomes across education groups, and SDH explain more than half of the gap in self-rated health and depressive symptoms. Health systems factors—primarily distance to health facility and unmet healthcare needs—account for 21% of the gap in depressive symptoms and 40% of the gap in self-rated health. Material factors, particularly disparities in household wealth, have the single greatest contribution to the inequalities in health, while physical activity and work also play important roles. 

Conclusions: The findings of this study highlight the need to address challenges in the delivery of health services and information, alleviate economic inequality, and promote healthier and active lifestyles to reduce health inequalities in the older population, aligning with global efforts to ensure healthy ageing for all.