S.V. Subramanian ^1*, Shailen Nandy ², Michelle Irving ², Dave Gordon ², Helen Lambert ², George Davey Smith ²

¹ Harvard School of Public Health
² University of Bristol

^* To whom correspondence should be addressed. E-mail: svsubram{at}hsph.harvard.edu.

	Abstract

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.

Key Words: Epidemiology, Geography, Global Health, Socioeconomic Factors, Mortality

This article has been cited by other articles:

				L. K. Ackerson and S. V. Subramanian Intimate Partner Violence and Death Among Infants and Children in India Pediatrics, November 1, 2009; 124(5): e878 - e889. [Abstract] [Full Text] [PDF]

				S V Subramanian and S Selvaraj Social analysis of sex imbalance in India: before and after the implementation of the Pre-Natal Diagnostic Techniques (PNDT) Act J Epidemiol Community Health, March 1, 2009; 63(3): 245 - 252. [Abstract] [Full Text] [PDF]

				L. K. Ackerson and S. V. Subramanian Domestic Violence and Chronic Malnutrition among Women and Children in India Am. J. Epidemiol., May 15, 2008; 167(10): 1188 - 1196. [Abstract] [Full Text] [PDF]

				L. K. Ackerson, I. Kawachi, E. M. Barbeau, and S.V. Subramanian Effects of Individual and Proximate Educational Context on Intimate Partner Violence: A Population-Based Study of Women in India Am J Public Health, March 1, 2008; 98(3): 507 - 514. [Abstract] [Full Text] [PDF]

				D. A Leon Cities, urbanization and health Int. J. Epidemiol., February 1, 2008; 37(1): 4 - 8. [Full Text] [PDF]

				L. K Ackerson, I. Kawachi, E. M Barbeau, and S V Subramanian Exposure to domestic violence associated with adult smoking in India: a population based study Tob. Control, December 1, 2007; 16(6): 378 - 383. [Abstract] [Full Text] [PDF]