title: Socio-economic inequalities in health and health service use among older adults in India: results from the WHO Study on Global AGEing and adult health survey.
abstract: OBJECTIVE
  The objectives of this study were to measure socio-economic inequalities in self-reported health (SRH) and healthcare visits and to identify factors contributing to health inequalities among older people aged 50-plus years.
  
  
  METHODS
  This study is based on a population-based, cross-sectional survey.
  
  
  METHODS
  We accessed data of 7150 older adults from the World Health Organization's Study on Global AGEing and adult health Indian survey. We used multivariate logistic regression to assess the correlates of poor SRH. We estimated the concentration index to measure socio-economic inequalities in SRH and healthcare visits. Regression-based decomposition analysis was employed to explore the correlates contributing to poor SRH inequality.
  
  
  RESULTS
  About 19% (95% CI: 18%, 20%) reported poor health (n = 1368) and these individuals were significantly less wealthy. In total, 5134 (71.8%) participants made at least one health service visit. Increasing age, female gender, low social caste, rural residence, multimorbidity, absence of pension support, and health insurance were significant correlates of poor SRH. The standardized concentration index of poor SRH -0.122 (95% CI: -0.102; -0.141) and healthcare visits 0.364 (95% CI: 0.324, 0.403) indicated pro-poor and pro-rich inequality, respectively. Economic status (62.3%), pension support (11.5%), health insurance coverage (11.5%), social caste (10.7%) and place of residence (4.1%) were important contributors to inequalities in poor health.
  
  
  CONCLUSIONS
  Socio-economic disparities in health and health care are major concerns in India. Achievement of health equity demand strategies beyond health policies, to include pro-poor, social welfare policies among older Indians.
authors.affiliation: Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Aarhus C 8000, Denmark. Electronic address: ethelbrinda84@gmail.com.
authors.forename: E M
authors.initials: EM
authors.lastname: Brinda
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C 8000, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Attermann
authors.affiliation: Health Economics Unit, Department of Clinical Sciences, Lund University, Lund 22381, Sweden; Institute of Economic Research, Health Economics & Management, Lund University, Lund 22007, Sweden.
authors.forename: U G
authors.initials: UG
authors.lastname: Gerdtham
authors.affiliation: Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Aarhus C 8000, Denmark.
authors.forename: U
authors.initials: U
authors.lastname: Enemark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006306:Health Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D014944:World Health Organization
keywords: Concentration index; Healthcare inequalities; India; Older adults; Socio-economic factors