Socioeconomic disparity in adult mortality in India: estimations using the orphanhood method

Abstract

Background: Due to a lack of data, no study has yet documented differences in adult life expectancy in India by education, caste, and religion. Objective: To examine disparities in socioeconomic status (SES) in the adult mortality rate (40q30) and life expectancy at age 15 (e15) in India. Data and methods: We estimated adult mortality by SES with the orphanhood method to analyze information related to the survival of respondents’ parents. We used data from the India Human Development Survey 2011–2012. SES was measured by education, caste, religion, and income of the either deceased adults or their offspring. Results: A consistency analysis between orphanhood estimates and official statistics confirmed the robustness of the estimates. Mortality is higher among adults who are illiterate, belong to deprived castes or tribes, have children with a low level of education, and have a low level of household income. The adult mortality rate varies marginally by religion in India. Life expectancy at 15 (e15) is about 3.50 and 5.7 years shorter for illiterate men and women, respectively, compared with literate men and women. The parameter e15 also varies significantly by educational attainment of offspring. On average, parents of children educated to higher secondary level (and above) gain an extra 3.8–4.6 years of adult life compared to parents of illiterate children. Disparity in e15 by caste and religion is smaller than disparity by education or income. Conclusion: The adult mortality burden falls disproportionately on illiterate adults and adults with less educated offspring. Thus, educational disparity in adult mortality appears to be prominent in Indian context. In the absence of adult mortality statistics by SES in India, we recommend that large-scale surveys should continue collecting data to allow indirect techniques to be applied to estimate mortality and life expectancy in the country.