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S.V. Subramanian, PhD, Shailen Nandy, MSc, Michelle Irving, BA, Dave Gordon, PhD, Helen Lambert, PhD and George Davey Smith, MD, DSc

S.V. Subramanian is with the Department of Society, Human Development and Health, School of Public Health, Harvard University, Boston, Mass. Shailen Nandy and Dave Gordon are with the School of Policy Studies, University of Bristol; Michelle Irving is with the Centre for the Study of Poverty and Social Justice, University of Bristol; and Helen Lambert and George Davey Smith are with the Department of Social Medicine, University of Bristol, Bristol, England.

Correspondence: Requests for reprints should be sent to S.V. Subramanian, PhD, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Ave, KRESGE 7th Floor, Boston, MA 02115-6096 (e-mail: svsubram{at}hsph.harvard.edu).

Objectives. 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.

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