Chandola Tarani, Mikkilineni Sitamma, Chandran Anil, Bandyopadhyay Souvik Kumar, Zhang Nan, Bassanesi Sergio Luiz
Department of Social Statistics, The Cathie Marsh Institute, University of Manchester, Manchester, UK.
IBS Business School, IFHE University, Hyderabad, India.
BMJ Open. 2018 Feb 10;8(2):e018885. doi: 10.1136/bmjopen-2017-018885.
Although urbanisation is generally associated with poverty reduction in low-income and middle-income countries, it also results in increased socioeconomic segregation of the poor. Cities with higher levels of socioeconomic segregation tend to have higher mortality rates, although the evidence is based on ecological associations. The paper examines whether socioeconomic segregation of the poor is associated with higher under-60 years ('premature') mortality risk in Indian cities and whether this association is confounded by contextual and compositional sociodemographic and socioeconomic factors.
A population representative sample of over one million from 39 427 households living in 1876 urban wards within 59 Indian districts (cities) from the third (2008) District Level Household Survey (DLHS-3).
The outcome was any death under the age of 60 reported by households in the preceding 4years of the DLHS-3. Socioeconomic segregation, estimated at the district (city) level, was measured using an isolation index of the poor and the index of dissimilarity.
Poor households living in cities where the poor were more isolated had higher probabilities of premature mortality than poor households living in cities where the poor were less isolated. In contrast, it did not matter whether rich households lived in more or less socioeconomically segregated cities. A 1 SD increase in the isolation index was associated with an absolute increase of 1.1% in the probability of premature mortality for the poorest households.
Increasing segregation of the poor may result in higher premature mortality. As low-income and middle-income countries become increasingly urbanised, there is a risk that this may lead to increased segregation of the poor as well as increased premature mortality.
尽管在低收入和中等收入国家，城市化通常与减贫相关，但它也导致穷人的社会经济隔离加剧。社会经济隔离程度较高的城市往往死亡率也较高，不过这一证据是基于生态关联。本文研究了印度城市中穷人的社会经济隔离是否与60岁以下（“过早”）死亡风险较高相关，以及这种关联是否会受到背景和构成性社会人口及社会经济因素的混淆。
来自印度59个地区（城市）1876个城市街区的39427户家庭的100多万人口代表性样本，数据来自第三次（2008年）地区级家庭调查（DLHS - 3）。
结局是DLHS - 3前4年家庭报告的60岁以下的任何死亡情况。在地区（城市）层面估计的社会经济隔离，使用穷人隔离指数和差异指数来衡量。
生活在穷人隔离程度较高城市的贫困家庭，其过早死亡的概率高于生活在穷人隔离程度较低城市的贫困家庭。相比之下，富裕家庭生活在社会经济隔离程度较高或较低的城市并无差异。隔离指数每增加1个标准差，最贫困家庭过早死亡概率的绝对增幅为1.1%。
穷人隔离加剧可能导致更高的过早死亡率。随着低收入和中等收入国家城市化程度日益提高，存在这样一种风险，即这可能导致穷人隔离加剧以及过早死亡率上升。
