The mortality divide in India: the differential contributions of gender, caste, and standard of living across the life course.
OBJECTIVE
We investigated the contributions of gender, caste, and standard of living to inequalities in mortality across the life course in India.


METHODS
We conducted a multilevel cross-sectional analysis of individual mortality, using the 1998-1999 Indian National Family Health Survey data for 529321 individuals from 26 states.


RESULTS
Substantial mortality differentials were observed between the lowest and highest standard-of-living quintiles across all age groups, ranging from an odds ratio (OR) of 4.61 (95% confidence interval [CI]=2.98, 7.13) in the age group 2 to 5 years to an OR of 1.97 (95% CI=1.68, 2.32) in the age group 45 to 64 years. Excess mortality for girls was evident only for the age group 2 to 5 years (OR=1.33, 95% CI=1.13, 1.58). Substantial caste differentials were observed at the beginning and end stages of life. Area variation in mortality is partially a result of the compositional effects of household standard of living and caste.


CONCLUSIONS
The mortality burden, across the life course in India, falls disproportionately on economically disadvantaged and lower-caste groups. Residual state-level variation in mortality suggests an underlying ecology to the mortality divide in India.
Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, KRESGE 7th Floor, Boston, MA 02115-6096, USA. svsubram@hsph.harvard.edu
S V
SV
Subramanian
Shailen
S
Nandy
Michelle
M
Irving
Dave
D
Gordon
Helen
H
Lambert
George
G
Davey Smith
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012111:Residence Characteristics; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors