Adult education and child mortality in India: the influence of caste, household wealth, and urbanization.
BACKGROUND
Although socioeconomic position is generally found to be related to health, the associations can be different for different measures of socioeconomic position. We examined the association between adult education and child mortality, and the influence of other socioeconomic markers (caste, household wealth, and urbanization) on this association.


METHODS
Data were drawn from the 1998-1999 Indian National Family Health Survey, conducted in 26 states and comprising 66,367 children age 5 years or under. Adult education, for the head of household and spouse, was categorized into 0, 1-8, and 9 or more years of schooling. We used logistic regression to estimate associations between education and child mortality in analysis adjusted for other socioeconomic markers. Effect modification by caste, household wealth, and urbanization was assessed by fitting an interaction term with education.


RESULTS
Compared with those who had no education, 9 or more years of education for the head of household and for the spouse were associated with lower child mortality (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.48-0.62 and OR = 0.44; 95% CI = 0.36-0.54, respectively) in analyses adjusted for age, sex, and state of residence. Further adjustments for caste and urbanization attenuated these associations slightly; when adjustments were made for household wealth the associations were attenuated more substantially. Nevertheless, in fully adjusted models, 9 or more years of education for the head of household (OR = 0.81; 95% CI = 0.70-0.93) and the spouse (OR = 0.75; 95% CI = 0.60-0.94) remained associated with lower child mortality. There was no effect modification of this association by caste, household wealth, and urbanization.


CONCLUSIONS
Adult education has a protective association with child mortality in India. Caste, household wealth, and urbanization do not modify or completely attenuate this association.
Singh-Manoux
Archana
A
INSERM, U687-IFR69, Hôpital Paul Brousse, Bâtiment 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France. archana.singh-manoux@st-maurice.inserm.fr
Dugravot
Aline
A
Smith
George Davey
GD
Subramanyam
Malavika
M
Subramanian
S V
SV
D019352:Censuses; D046688:Child Mortality; D002675:Child, Preschool; D004522:Educational Status; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006306:Health Surveys; D006801:Humans; D007182:Income; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D012923:Social Class; D012959:Socioeconomic Factors; D014507:Urbanization