Department of Epidemiology, University of Alabama at Birmingham, 533B RPHB, 1665 University Blvd, Birmingham, AL, 35233, USA.
Department of Sociology, University of Alabama at Birmingham, 460 Heritage Hall Building, 1401 University Blvd, Birmingham, AL, 35233, USA.
J Racial Ethn Health Disparities. 2020 Oct;7(5):987-995. doi: 10.1007/s40615-020-00723-9. Epub 2020 Feb 20.
The caste system is a relatively rigid system of social hierarchy in India. The caste membership defines one's access to resources and life opportunities. A growing body of research suggests that lower caste groups have an excess burden of morbidity and mortality in India. However, it is not clear as to what extent caste differences in health are conditioned by socioeconomic status (SES) indicators.
This study examined the caste differences in hypertension and tested whether caste differences in hypertension are conditioned by education and household wealth in a representative sample of women in India.
This study used data from the National Family Health Survey (NFHS) 2015-2016, India. The analysis is based on a nationally representative sample of 648,064 adult women aged 15-49 years. We used logistic regression to examine whether the association between caste and hypertension varied by education and wealth index using interactions and controlling for potential confounders.
The regression models suggest that scheduled tribes and non-caste members have the highest odds of hypertension compared with privileged upper caste members. Interaction models indicate complex intersections of caste, education, and wealth index. The predicted probabilities derived from these interaction models suggest that while SES indicators are inversely associated with the odds of hypertension, the inverse patterning was significantly weaker in other backward classes and more protective in non-caste members compared with upper caste. Additionally, caste difference in predictive risk of hypertension tends to diverge at the lower levels of SES and become narrower at the higher levels of SES.
These findings provide evidence of differential returns to SES and have implications for understanding the causes of SES patterning in health among disadvantaged caste groups in India.
种姓制度是印度一种相对僵化的社会等级制度。种姓成员决定了一个人获取资源和生活机会的能力。越来越多的研究表明，低种姓群体在印度的发病率和死亡率过高。然而，种姓差异对健康的影响在多大程度上受到社会经济地位（SES）指标的影响还不清楚。
本研究考察了高血压的种姓差异，并检验了在印度代表性的女性样本中，种姓差异在高血压方面是否受到教育和家庭财富的影响。
本研究使用了 2015-2016 年印度国家家庭健康调查（NFHS）的数据。该分析基于一个全国代表性的样本，包括 648064 名年龄在 15-49 岁的成年女性。我们使用逻辑回归检验了种姓与高血压之间的关联是否因教育和财富指数而有所不同，使用了交互作用并控制了潜在的混杂因素。
回归模型表明，与特权的上层种姓成员相比，在册部落和非种姓成员患高血压的几率最高。交互模型表明，种姓、教育和财富指数之间存在复杂的交叉。从这些交互模型中得出的预测概率表明，尽管 SES 指标与高血压的几率呈负相关，但在其他落后阶层中，这种反向模式的显著减弱程度更高，而非种姓成员的保护作用更强，而上层种姓成员则更强。此外，种姓差异在预测高血压风险方面的趋势在 SES 较低水平上趋于发散，在 SES 较高水平上趋于变窄。
这些发现提供了 SES 回报存在差异的证据，并对理解印度弱势种姓群体 SES 模式在健康方面的原因具有启示意义。
