Subramanian S V, Nandy Shailen, Irving Michelle, Gordon Dave, Lambert Helen, Davey Smith George
Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, KRESGE 7th Floor, Boston, MA 02115-6096, USA.
Am J Public Health. 2006 May;96(5):818-25. doi: 10.2105/AJPH.2004.060103. Epub 2006 Mar 29.
We investigated the contributions of gender, caste, and standard of living to inequalities in mortality across the life course in India.
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.
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.
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.
我们研究了性别、种姓和生活水平对印度全生命周期死亡率不平等的影响。
我们利用1998 - 1999年印度全国家庭健康调查数据，对来自26个邦的529321个人的个体死亡率进行了多层次横断面分析。
在所有年龄组中，最低和最高生活水平五分位数之间存在显著的死亡率差异，2至5岁年龄组的优势比（OR）为4.61（95%置信区间[CI]=2.98, 7.13），45至64岁年龄组的OR为1.97（95% CI=1.68, 2.32）。仅在2至5岁年龄组中，女孩的超额死亡率明显（OR=1.33, 95% CI=1.13, 1.58）。在生命的开始和结束阶段观察到显著的种姓差异。死亡率的地区差异部分是家庭生活水平和种姓构成效应的结果。
在印度的全生命周期中，死亡负担不成比例地落在经济上处于不利地位的群体和低种姓群体身上。邦一级死亡率的残余差异表明印度死亡率差异存在潜在的生态因素。
