Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India.
Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India.
Sci Rep. 2022 Apr 22;12(1):6644. doi: 10.1038/s41598-022-10583-4.
With wide socioeconomic mortality differential among older adults in India, a constant question of death clustering across high-risk families and communities arises. The present study uses a follow-up survey from India to investigate the socioeconomic, demographic and health predictors of old-age mortality clustering. Data of 16,964 older adults nested within 12,981 households from 2352 communities were used from India Human Development Survey (IHDS) round-I (2005) who were further tracked down in round-II (2012). Bivariate association between the determinants of old-age mortality was investigated using the log-rank test. The multivariate analysis involved estimating the random-intercept Weibull proportional hazard model with three levels-individual (level 1), family (level 2) and community (level 3). We analyzed the sensitivity of multivariate results to unobservable variable and selection biases using the e-value method. The empirical analysis confirms that the risk of mortality is significantly heterogeneous between the families. The health status of older adults and the family's socioeconomic status in the early years emerged as prominent predictors of a longer lifespan. With a strong association between household income and mortality hazard risk, the present study urges early life interventions as those started in late-life might have negligible impact on keeping the older adults alive and healthy.
在印度，老年人的社会经济死亡率存在广泛差异，因此出现了一个持续存在的问题，即死亡在高风险家庭和社区中聚集。本研究利用印度人类发展调查（IHDS）第一轮（2005 年）的后续调查，调查了老年死亡率聚集的社会经济、人口和健康预测因素。该调查数据来自印度 2352 个社区的 12981 户家庭中的 16964 名老年人，这些老年人在第二轮（2012 年）中进行了跟踪调查。使用对数秩检验调查老年死亡率决定因素之间的双变量关联。多变量分析涉及使用具有三个层次（个体（第 1 层）、家庭（第 2 层）和社区（第 3 层）的随机截距 Weibull 比例风险模型来估计。我们使用有效值方法分析了多变量结果对不可观测变量和选择偏差的敏感性。实证分析证实，家庭之间的死亡率风险存在显著异质性。老年人的健康状况和家庭早年的社会经济地位是长寿的突出预测因素。由于家庭收入与死亡率风险之间存在很强的关联，本研究敦促进行早期生活干预，因为在晚年开始干预可能对保持老年人的生命和健康没有影响。
