The mortality divide in India: the differential contributions of gender, caste, and standard of living across the life course

Am J Public Health. 2006 May;96(5):818-25. doi: 10.2105/AJPH.2004.060103. Epub 2006 Mar 29.


Objectives: We investigated the contributions of gender, caste, and standard of living to inequalities in mortality across the life course in India.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Humans
  • India / epidemiology
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Mortality*
  • Residence Characteristics
  • Sex Factors
  • Social Class*
  • Socioeconomic Factors