Explaining the social gradient in health: inequality in health outcomes in selected states of India, 2015‑2016

Introduction
This study tries to investigate the relative strengths of social and economic status in determining the health status or outcomes in terms of life expectancy of persons in selected states of India.

Material and methods
We analysed cross-sectional household-level survey data from the fourth round of the National Family Health Survey which was conducted between 2015 and 2016. The age at death was calculated for state comparison, while multiple logistic regression was carried out to understand the effect of conditioning variables (social, economic, and demographic) on age at death.

Results
Amongst the selected states, Bihar has the lowest life expectancy of people in each social category along with the Muslim households. Females had a marginally higher life expectancy than males. Persons in urban locations had a 4 percentage points higher life expectancy than persons in rural locations. The coefficients suggest a positive association between economic status and age at death. Those from the poorest quantile had a considerably higher likelihood of age at death. Socio-economic status, sex, place of residence, and housing environment were found to be the major predictors for age at death.

Conclusions
The study has shown that if a person stands at the bottom of the social ladder in India, the risk of suffering premature death, poor health, and lack of access to treatment and care is substantially higher. This phenomenon has serious social and economic implications for the country and warrants immediate policy interventions where people matter and social justice is supreme.