Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, USA.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
J Health Popul Nutr. 2022 May 12;41(1):19. doi: 10.1186/s41043-022-00298-7.
Community characteristics are a significant social determinant of child health. Little is known about the effects of social heterogeneity as a specific factor that might impact health. This paper aims to fill the void in research on the health effects of India's district-level religious heterogeneity.
Weighted state fixed effects multivariate logistic regression was applied to India's Third District Level Household Survey (2007-2008). The dependent variables were death of a child under five and indicators of healthcare utilization. The key independent variables were the proportions in the district who were Hindu, Muslim, Christian, Buddhist, and Sikh. The analysis controlled for generic community diversity, household religion, and socioeconomic status. Separate, sub-group analysis focused on Muslims only, Christians only, and Buddhists only.
Multivariate fixed effects models show that a 1% point increase in the proportion of Muslim, Christian, or Buddhist households in a community is associated with respective odds ratios of child death of 1.008, 1.009, and 1.012 of experiencing the death of a child. The impact of a household's own religious affiliation is statistically insignificant in these models. Higher proportions of Muslims and Christians in a community lower the odds of BCG (a vaccine for childhood tuberculosis) receipt and child healthcare-seeking.
Households residing where there are higher levels of religious minorities in India experience worse child survival. These effects are not mediated by the household's own religious affiliation. There is evidence that health system performance and quality is systematically worse in communities with higher proportions of religious minorities. Our study can help policymakers identify communities where children may be at higher risk based on community heterogeneity and the potential for insufficient collective action. Policymakers might consider flagging these communities for special attention, because social heterogeneity is likely to be of long duration.
社区特征是儿童健康的一个重要社会决定因素。人们对社会异质性作为一个可能影响健康的特定因素的影响知之甚少。本文旨在填补印度地区宗教异质性对健康影响研究的空白。
本文运用加权州固定效应多元逻辑回归分析方法，对印度第三次地区家庭调查（2007-2008 年）的数据进行分析。因变量为五岁以下儿童死亡和医疗保健利用指标。关键自变量为该地区印度教徒、穆斯林、基督教徒、佛教徒和锡克教徒的比例。分析中控制了一般社区多样性、家庭宗教和社会经济地位。分别对穆斯林、基督教徒和佛教徒进行了亚组分析。
多元固定效应模型表明，社区中穆斯林、基督教徒或佛教徒家庭比例每增加 1%，儿童死亡的几率分别增加 1.008、1.009 和 1.012。在这些模型中，家庭自身宗教信仰的影响在统计学上并不显著。社区中穆斯林和基督教徒比例较高，会降低儿童接受卡介苗（一种预防儿童结核病的疫苗）接种和寻求儿童医疗保健的几率。
在印度，居住在宗教少数群体比例较高的社区的家庭，其儿童的生存状况更差。这些影响不是由家庭自身的宗教信仰所介导的。有证据表明，在宗教少数群体比例较高的社区，卫生系统的绩效和质量较差。我们的研究可以帮助政策制定者根据社区异质性和集体行动不足的可能性，确定儿童面临更高风险的社区。政策制定者可能会考虑将这些社区标记出来，给予特别关注，因为社会异质性可能会持续很长时间。
