Explaining the Urban-Rural Difference in Late-Life Depression in India: Evidence from a Multivariate Decomposition Analysis Based on Longitudinal Aging Study in India, Wave 2017-18.

OBJECTIVES: The study explored the associated factors of depression among older Indian adults and the influences of individual and socio-environmental factors in explaining the rural-urban difference in the prevalence of late-life depression. METHODS: Data come from the Longitudinal Aging Study in India, with a sample of 30,637 older adults aged 60 and above. Multivariable logistic regression and nonlinear multivariate decomposition analyses were conducted to fulfill the objectives. RESULTS: About 6.2% older adults in urban areas and 9.5% in rural areas were depressed. Older adults in rural areas had significantly higher likelihood to be depressed than those in urban areas. Poor self-rated health, multiple chronic conditions, functional difficulty, low life satisfaction, social inactivity, low satisfaction with living arrangement, ill-treatment and being widowed increased the risk of depression. Additionally, work status similar to urban older adults, physical activity, living arrangement satisfaction, self-rated health and ill-treatment would decrease the urban-rural difference in depression. CONCLUSIONS: The study showed significant rural-urban difference in late-life depression, with a rural disadvantage. CLINICAL IMPLICATIONS: The findings suggest the need for identifying at-risk populations and developing a framework of targeted policy interventions for mitigating the increased risk of late-life depression among older Indians and in rural areas in particular.

Multivariate decomposition of gender differentials in successful aging among older adults in India.

BACKGROUND: Rowe and Kahn define successful aging as a high physical, psychological, and social functioning in old age without major diseases. It is considered a viable solution to the burdens placed on healthcare systems and financial and social security in societies with aging population. The present study aimed to determine the prevalence of successful aging and explore the factors contributing to gender differentials in successful aging among older adults in India. METHODS: This study utilized data from the nationally representative Longitudinal Ageing Study in India, conducted in 2017-18. The study is based on a sample of 15,098 older men and 16,366 older women aged 60 years and above. The outcome variable was a dichotomous measure of successful aging with six components including absence of chronic diseases, free from disability, high cognitive ability, free from depressive symptoms, active social engagement in life and free from obesity. Older adults satisfying all these conditions were considered aging successfully. Descriptive and bivariate analyses were carried out. Proportion test was used to evaluate the gender differentials and reflect the statistical significance in the associated factors. Multivariate decomposition analysis was conducted to identify covariates' contribution in explaining the gender differences in successful aging. RESULTS: There was a significant gender difference in successful aging among older adults in India (Difference: 8.7%; p-value < 0.001] with 34.3% older men and 25.6% older women experiencing successful aging. A proportion of 88% of gender difference in successful aging was explained by the differences in the distribution of characteristics (Coef: 0.082; p-value < 0.05). Considerable gender gap in successful aging would be reduced if women had similar levels of work status (28% reduction) to their male counterparts. Bringing the level of frequent physical activity in women to the same levels observed in men would reduce the gender gap by 9%. CONCLUSIONS: The findings suggest that women had a lower score in successful aging, which is attributed to several socioeconomic and behavioural factors including not working status and physical inactivity. More studies must be done to explore the reasons for such differences and what particular factors in low-income countries create differences among older men and women in achieving successful aging.

Decomposition of caste differential in life satisfaction among older adults in India.

BACKGROUND: Being a multi-cultured country, India has varied social groups which largely shape the lives of individuals. Literature has shown that life satisfaction is highly associated with the social status of individuals. However, changing age dynamics (growing older) and definition of life among people presses the need to understand whether the additional years of life in older adults are manifested with the disparity in life satisfaction among the Scheduled Caste (SC)/ Scheduled Tribes (ST) and non-SC/ST social groups in recent years. The present study explored the factors contributing to such differences in life satisfaction across social groups. METHODS: This study used data from the Longitudinal Aging Study in India conducted during 2017-18. The analytical sample of the study was 30,370 older adults. Life satisfaction was the outcome variable with a score ranging from 5 to 35. Descriptive statistics and bivariate analysis were conducted. Simple linear regression analysis was used to establish the association between the outcome and explanatory variables. Further, the Blinder-Oaxaca decomposition model was used to analyse the role of explanatory factors in the caste difference in life satisfaction among older people. RESULTS: Overall, the life satisfaction score among older adults in the study was 23.9 (SD- 7.3). Older adults from non-SC/ST group had significantly higher likelihood of having life satisfaction in comparison to older adults from SC/ST group [Coef: 0.31; CI: 0.14, 0.49]. The decomposition results showed that the model explained 74.3% of the caste gap (between SC/ST and non-SC/ST) in life satisfaction among older adults in India. Subjective social status (39.0%) was widening the gap for life satisfaction among older adults from SC/ST and non-SC/ST group. Similarly, level of education (15.2%) followed by satisfaction with living arrangement (13.2%) and place of residence (5.3%) contributed for widening the gap for life satisfaction among older adults from SC/ST and non-SC/ST group. Region of country (- 11.5%) followed by self-rated health (- 3.0%) and major depression (- 2.7%) contributed for narrowing down the gap for life satisfaction among older adults from SC/ST and non-SC/ST group. CONCLUSION: Older adults belonging to non-SC/ST groups were more likely to have a higher level of life satisfaction than those from the SC/ST group. Factors like subjective social status, educational level, living arrangement satisfaction, and place of residence explained the caste differential in life satisfaction among older adults. In addition, factors such as psychological health and perceived health status should be the area of concern and special focus for policy makers and researchers in terms of reducing social inequalities in wellbeing among older population.

Association of mass media exposure with combustible and smokeless tobacco use among Indian population: findings from a panel survey.

BACKGROUND: Despite introducing different policies and initiatives, India is recognized as one of the global players in the tobacco epidemic race. Our study explores the association between tobacco consumption and mass media exposure among the Indian population, considering the contextual factors affecting the clustering at the community and state levels. METHODS: Using two waves of the India Human Development Survey (IHDS) conducted in 2005 and 2012 for 16,661 individuals, the present study explores the association of mass media exposure and tobacco consumption in the short-term and the long-term period of Cigarettes and Other Tobacco Products Act (COTPA) implementation, which came into existence in 2004. Bivariate analysis using the chi-square test for association showed the correlation of tobacco consumption with its respective predictors. Multivariable analysis using three-level random intercept logit models showed the adjusted association between tobacco consumption and its relevant covariates and the extent of clustering of tobacco consumption behaviour of persons in the communities and states. RESULTS: We found that watching television (TV) [(OR:1.03; CI:0.92-1.15) in 2004-05 and (OR:0.99; CI:0.88-1.12) in 2011-12], listening radio [(OR: 0.99; CI:0.90-1.10) in 2004-05 and (OR:1.04; CI:0.94-1.15) in 2011-12] and reading newspaper [(OR:1.02; CI:0.91-1.15) in 2004-05 and (OR:0.96; CI:0.87-1.06) in 2011-12] did not have any significant effect on consumption of combustible tobacco. Similarly, no effect of mass media was found on smokeless tobacco consumption. Further, the clustering of combustible and smokeless tobacco usage was higher at the community level than at the state level. In both rounds, smokeless tobacco consumption was found to be higher than combustible tobacco. DISCUSSION: The present study provides evidence that COTPA has achieved its aim of nullifying the significant effect of mass media on combustible and smokeless tobacco consumption among the Indian population. However, the influence of state- and community- level clustering had failed in curbing the increment of smokeless tobacco consumption. There is a need for policy reforms to curb the significant impact of factors that promotes smokeless tobacco consumption in India. Further, initiatives must focus on specific communities from high-risk states, reducing the time and cost required for implementation.

Effect of change in individual and household level characteristics on anemia prevalence among adolescent boys and girls in India.

BACKGROUND: Anemia is a significant public health challenge that affects the population of all nations. Anemia among adolescents emerged as an alarming public health issue as it harms an individual's physical capacity and cognitive and work performance. The study aims to determine the effect of changes in individual and household level factors on the prevalence of anemia among adolescent boys and girls. METHOD: The study utilized data from two waves of the "Understanding the lives of adolescent and young adults" (UDAYA) survey, conducted in Bihar and Uttar Pradesh during 2015-16 (wave-1) and 2018-19 (wave-2). The sample size for the present study was 4216 and 5974 unmarried adolescent boys and girls aged 10-19 years in both waves. We performed descriptive analysis to observe the characteristics of adolescents during 2015-16. Further, changes in selected independent variables from wave-1 to wave-2 were examined using the proportion test. Moreover, random-effect regression models were employed to examine the association of changes in individual and household level factors with anemia prevalence among adolescents. RESULTS: The prevalence of anemia decreased over time among adolescent boys (33 to 30%), whereas it increased among adolescent girls (59 to 63%). The results from the random-effect model show that adolescent boys who used shared toilets were more anemic than those who used a private restroom [ß:0.05, 95% CI:(0.01, 0.08)]. Moreover, underweight [ß:0.05, CI:(0.01, 0.09)] and thin [ß:0.04, CI:(0.00, 0.07)] adolescent boys were more likely to be anemic compared to their normal counterparts. Additionally, boys who belonged to the poorest [ß:0.08, CI:(0.02, 0.14)] households had a higher risk of anemia than the richest household. CONCLUSION: The anemia prevalence was higher among adolescents aged 10-19 years in Uttar Pradesh and Bihar. This study has filled an information gap by providing state-level representative estimates indicating underweight status and thinness as the common factors behind the anemia prevalence among adolescent boys than in girls. Iron deficiency anemia is the most prevalent in certain age groups in India. Hence, Anemia prevention efforts and iron-folic acid (IFA) supplementation programs are currently being strengthened in India, targeting the high-risk population.

Indigenous population and major depressive disorder in later life: a study based on the data from Longitudinal Ageing Study in India.

BACKGROUND: Existing evidence suggests that the indigenous older population who live with their families and friends might experience lesser depressive symptoms due to better emotional support and well-being. The present study aimed to investigate the differentials in the prevalence of the major depressive disorder among tribal and non-tribal older populations in India and to explore the contribution of socio-demographic, health-related, and household factors in such disparities. METHODS: A cross-sectional study was conducted using data from the Longitudinal Aging Study in India (2017-18). The analytical sample included 30,637 older adults, among whom 5,025 and 25,612 belonged to the Scheduled Tribe (ST) and non-Scheduled Tribe (non-ST) social groups, respectively. Major depressive disorder assessed by the Composite International Diagnostic Interview short-form (CIDI-SF) scale was the outcome variable. Descriptive statistics, bivariate and multivariable regression and, decomposition analyses were conducted. RESULTS: About 4.8% and 8.9% of older adults from the ST and non-ST social groups had major depression. For both tribal and non-tribal groups, older adults who were unmarried, dissatisfied with living arrangements, and those who faced lifetime discrimination were at increased risk of major depression. Findings from differences due to characteristics (E) revealed that if the regional differences were minimized, it would decrease the ST-non-ST gap in major depression by about 19.6%. Similarly, equal self-rated health status and chronic conditions among ST and non-ST groups would decrease the gap in major depression by almost 9.6% and 7.9%, respectively. Additionally, an equal status of Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) among older adults would decrease the gap in major depression by about 3.8% and 3% respectively. Also, findings from differences due to coefficients (C) revealed that if older adults from the ST group had the same status of ADL as of older adults from the non-ST group, it would decrease the gap in major depression by about 11.8%. CONCLUSION: The findings revealed a greater prevalence of major depression in older adults belonging to the non-ST group than the ST group. For both tribal and non-tribal groups, older adults who were unmarried, dissatisfied with living arrangements, and those who faced lifetime discrimination were at increased risk of major depression and these factors along with health-related variables contributed to significant ST-non-ST gap in depression, advantageous to tribal population; suggesting further research on the coping mechanisms of mental illnesses among indigenous population in India.

Determinants of multimorbidity of infectious diseases among under-five children in Bangladesh: role of community context.

BACKGROUND: The presence of more than one morbid condition among children has become a global public health concern. Studies carried out in Bangladesh have primarily focused on diarrhoea and acute respiratory tract infections independently without considering their co-occurrence effect. The present study examines the multimorbid conditions of infectious diseases in under-five Bangladeshi children. It explores multimorbidity determinants and the role of community context, which are often overlooked in previous literature. METHODS: Utilizing the most recent Demographic and Health Survey of Bangladesh (2017-18), we used mixed-effects random-intercept Poisson regression models to understand the determinants of multimorbidity of infectious diseases in under-five Bangladeshi children considering the community-level characteristics. RESULTS: The present study found that 28% of the children experienced multimorbidity two weeks prior to the survey. Community-level variability across all the statistical models was statistically significant at the 5% level. On average, the incidence rate of multimorbidity was 1.34 times higher among children from high-risk communities than children from low-risk communities. Moreover, children residing in rural areas and other urban areas involved 1.29 [CI: 1.11, 1.51] and 1.28 [CI: 1.11, 1.47] times greater risk of multimorbidity respectively compared to children from city corporations. Additionally, the multimorbidity incidence was 1.16 times [CI: 1.03, 1.30] higher among children from high-altitude communities than children living in low-altitude communities. CONCLUSION: The significant effect of public handwashing places suggests community-based interventions among individuals to learn hygiene habits among themselves, thus, the severity of coexistence nature of infectious diseases. A higher incidence of coexistence of such infectious diseases in the poor and semi-urban populace further recommends a targeted awareness of a clean environment and primary healthcare programmes.

Determinants of acquired disability and recovery from disability in Indian older adults: longitudinal influence of socio-economic and health-related factors.

BACKGROUND: There is a higher burden of functional disability for Indian older adults with substantial variations across different geographic regions and socioeconomic groups as compared to other ageing Asian countries. Thus, using a national sample of older adults aged 60+ years, we aim to explore how common is acquiring of disability and recovery from disability among the older population of a developing country like India, and how do the various socioeconomic and health-related conditions impact this transition in disability status. METHOD: The current study uses two waves of the India Human Development Survey (IHDS) and is based on panel data of 10,527 older adults. Both bivariate and multiple variable regression analysis were performed using two binary outcome variables in this study - whether older adults acquired disability and recovered from disability between round-I and round-II, respectively. RESULTS: Nearly 31.5% and 4.4 % of older adults have acquired and recovered disability across the two rounds respectively. About 38.5%  and 45.8 % of female older adults' disability status changes to disable and recovered in round-II respectively. A lesser proportion of older adults have recovered from a disability who have a chronic disease in round-I. Cataract chronic conditions among older adults in round-I had shown 1.45 times (CI: 1.07-1.97) a significantly higher likelihood of acquiring disability in round-I. Older adults who were unmarried and were not working in round-I have 1.12 times (CI: 1.01-1.25) and 1.21 times (CI: 1.06-1.39) higher likelihood of acquiring disability in round-II respectively. Recovering from disability was mostly seen among older adults who belong to the richest (OR: 2.38, CI: 1.31-4.33) and medium (OR: 2.16, CI: 1.27-3.69) wealth quintile households. Older adults residing in the central region of India have 2.72 times (CI: 2.31-3.19) significantly higher chance of acquiring disability than those who were residing in northern regions. CONCLUSION: Appropriate measures are required to highlight the importance of chronic physical diseases and several socio-demographic factors that may negatively affect the trajectory of disability in older ages.

Differential in infant, childhood and under-five death clustering among the empowered and non-empowered action group regions in India.

BACKGROUND: With 8,82,000 deaths in the under-five period, India observed varied intra-state and inter-regional differences across infant and child mortality in 2018. However, scarce literature is present to capture this unusual concentration of mortality in certain families by examining the association of the mortality risks among the siblings of those families along with various unobserved characteristics of the mother. Looking towards the regional and age differential in mortality, this paper attempts to provide evidence for the differential in mortality clustering among infants (aged 0-11 months), children (12-59 months) and under-five (0-59 months) period among mothers from the Empowered Action Group (EAG) and non-EAG regions of India. METHODS: The study used data from the National Family Health Survey (2015-16) which includes all the birth histories of 475,457 women aged 15-49 years. Bivariate and multivariate analyses were used to fulfil the objectives of the study. A two-level random intercept Weibull regression model was used to account for the unexplained mother (family) level heterogeneity. RESULTS: About 3.3% and 5.9% of infant deaths and 0.8% and 1.6% of childhood deaths were observed in non-EAG and EAG regions respectively. Among them, a higher percentage of infant and child death was observed due to the death of a previous sibling. There were 1.67 times [95% CI: 1.55-1.80] and 1.46 times [CI: 1.37-1.56] higher odds of infant and under-five mortality of index child respectively when the previous sibling at the time of conception of the index child was dead in the non-EAG regions. In contrast, the odds of death scarring (death of previous sibling scars the survival of index child) were 1.38 times [CI: 1.32-1.44] and 1.24 times [CI: 1.20-1.29] higher for infant and under-five mortality respectively in the EAG regions. CONCLUSION: The extent of infant and child mortality clustering and unobserved heterogeneity was higher among mothers in the non-EAG regions in comparison to their EAG region counterparts. With the growing situation of under-five mortality clustering in non-EAG states, region-wise interventions are recommended. Additionally, proper care is needed to ameliorate the inter-family variation in mortality risk among the children of both EAG and non-EAG regions throughout their childhood.

Does substance use by family members and community affect the substance use among adolescent boys? Evidence from UDAYA study, India.

BACKGROUND: Substance use among adolescents is risky behavior that had emerged as a concern in both developed and developing countries. Evidence revealed that substance use is more frequent among those adolescents whose immediate family members (parents, siblings and grandparents) also indulge in such consumption; however, scarce literature is present in the Indian context. Therefore, the present study examined whether substance use among family members and in the community is associated with the substance use behavior of adolescent boys in Uttar Pradesh and Bihar. METHOD: We used the data for 5969 adolescent boys aged 10-19 years from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey conducted in 2016. A three-level random intercept logit model was utilized to understand the association of adolescent substance use behavior with familial and community context. RESULTS: We found that 16% of adolescent boys were using any substance (tobacco or alcohol or drug). The substance use was significantly higher among adolescent boys who were school dropouts (40%) than those who were currently in school. The prevalence of substance use is also high among those who were working (35%). Moreover, 19, 24 and 28% of the adolescents come from families where at least one of the family members consumed tobacco, alcohol and drugs, respectively. The odds of substance use were 2.13 times [CI:1.44-3.17] higher among those adolescent boys whose family members also indulged in substance use. Moreover, the likelihood of substance use was 1.24 times [CI:1.01-1.68] higher among the adolescent boys who come from a community with high substance use. Additionally, the risk of substance use is more likely among adolescent boys belonging to the same household of the same community. CONCLUSION: It is evident that exposure to substance use in the family and community increases the likelihood of substance use among adolescent boys. There is a need for household- and community-level programmatic interventions to alleviate the risk of substance use among adolescents.

Neonatal and Postneonatal Death Clustering Among Siblings in Bangladesh: Evidence from Bangladesh Demographic and Health Survey 2017-2018.

Despite knowledge of neonatal and postneonatal mortality determinants in Bangladesh, some families continue to lose a larger share of children, a phenomenon known as early-life mortality clustering. This study uses the random intercept Weibull survival regression model to explore the correlation of mortality risk among siblings at the family (or, mother) and community levels. Utilizing the Bangladesh Demographic and Health Survey 2017-2018, we found evidence of death scarring, where children whose previous sibling was not alive at the time of conception had significantly higher odds of neonatal mortality. Moreover, the neonatal (and postneonatal) mortality hazard was highest for children with a birth interval of fewer than 19 months, corresponding to the preceding sibling. The intraclass correlation coefficient's statistically significant values show that neonatal and postneonatal mortality risk is correlated among children of the same family and community. The findings suggest focusing on high-risk families and communities to reduce the mortality level effectively.

Depression by gender and associated factors among older adults in India: implications for age-friendly policies.

Inspite of implementing policies to control mental health problems, depression remains a severe health concern among older adults in India. We examined self-reported differences in the depression among older men and women in India and examined associated factors for gender differences in depression at the population level. We utilized nationally representative data from the Longitudinal Aging Study in India (LASI) wave I, for years 2017-2019. Our analytical sample comprised of 30,637 older adults ages 60 years and above (14,682 men and 15,655 women). We conducted descriptive statistics and Chi-Square tests followed by binary logistic regression and multivariate decomposition analyses to examine our study objectives. Depression was reported in - 7.4% (95% CI 7.0, 7.8) of older men and 9.5% (CI 9.1, 10.0) of older women. Poor self-rated health, multimorbidity status, physical activity, difficulty in activities of daily living (ADL) and instrumental ADL (IADL) were the significant health-related factors associated with depression among older men and women. Not being satisfied with one's life, not being satisfied with their present living arrangement, receiving any type of ill-treatment, and being widowed were the significant factors associated with depression among older men and women. We found gender disparity in self-reported depression. Marital status contributed-to 36.7% of the gender gap in depression among older adults. Additionally, ADL and IADL difficulties among men and women contributed to 17.6% and 34.0%, gender gap, self-rated health contributed to 18.8% gap, whereas not having equal social participation (4.4%) and not satisfied in present living arrangements (8.1%) were other factors that contributed to gender gap for depression in India. Depression is a critical and persistent public health problem among-older females in India. Our findings provide a broader framework for policymakers and health practitioners to focus on gender-specific strategies to mitigate this highly emergent problem.

Risk factors and clustering of mortality among older adults in the India Human Development Survey.

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.

Early childhood circumstances and educational wellbeing inequality among tribal and non-tribal children in India: evidence from a panel study.

Despite efforts towards bridging the education gap between tribal (Scheduled Tribe) and non-tribal (Non-Scheduled Tribe) children, contrasting poor-quality education questioned the tribal children's educational wellbeing in India. Early childhood circumstances render a remarkable impact on the educational wellbeing of children in later years. This study examined the influence of early childhood circumstances (child, household and community characteristics) during 2005 on the educational wellbeing inequality (among India's tribal and non-tribal children) during 2012 using the India Human Development Survey panel dataset of 8611 children. The Educational wellbeing score was obtained from reading, mathematical and writing test scores using Principal Component Factor Analysis. We performed the Blinder-Oaxaca decomposition of the educational wellbeing inequality among India's tribal and non-tribal children. The ST children's average educational wellbeing score (-0.41) was much lower than the Non-ST children (0.04). Findings from the Blinder-Oaxaca decomposition show that the household economic condition in children's early ages contributed to 24% of educational wellbeing inequality among tribal and non-tribal children. Further, the education status of males and female adults and the sanitation condition of families considerably impacted educational wellbeing. The present study concludes that caste antagonism has not reduced with time. The missing focus on the minority groups resulted in a deteriorated educational wellbeing.

Examining infant and child death clustering among families in the cross-sectional and nationally representative Bangladesh Demographic and Health Survey 2017-2018.

OBJECTIVES: We aim to examine the phenomenon of infant and child death clustering while considering the unobserved heterogeneity (frailty) at the family level. DESIGN, SETTING, AND PARTICIPANTS: We analysed Bangladesh Demographic and Health Survey 2017-2018 data, including the birth history information for 47 828 children born to 18 134 women. We used Gompertz shared frailty model to control the correlation between event times at the mother level and capture the unobserved risks in infant and child deaths. OUTCOME MEASURES: We estimated two sets of survival regression models where the failure event is the survival status of the index child during the infancy period, that is, from birth to 11 months, and childhood period, that is, between 12 and 59 months, respectively. All children who died during infancy and childhood were coded as 'yes'; otherwise, they were coded as 'no'. RESULTS: About 2% of mothers experienced two or more infant deaths, and cumulatively these mothers account for 20% of all infant deaths in the sample. Children whose previous sibling was not alive at the time of their conception had 1.86 times (95% CI 1.59 to 2.17) more risk of dying as an infant. However, we did not find a statistically significant effect of death scarring on the risk of child mortality among siblings. Statistically significant frailty effect with a variance of 0.33 (95% CI CI 0.17 to 0.65) and 0.54 (95% CI 0.14 to 2.03)] in infancy and childhood, respectively, indicates the clustering of survival risks within families due to unobserved family-level characteristics shared by the siblings. CONCLUSION: This study suggests that preceding birth interval, mother's age at first birth and mother's education are the most critical factors which can help in reducing scaring effect on infant mortality. Additionally, women from poor socioeconomic strata should be focused on as still an infant, and child mortality is concentrated among poor households.

Multivariate decomposition analysis of sex differences in functional difficulty among older adults based on Longitudinal Ageing Study in India, 2017-2018.

OBJECTIVES: This study investigates the gender disparities in difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) and explores its contributing factors among older adults in India. DESIGN: A cross-sectional study was conducted using country representative survey data. SETTING AND PARTICIPANTS: The present study uses the data from the Longitudinal Ageing Study in India, 2017-2018. Participants included 15 098 male and 16 366 female older adults aged 60 years and above in India. PRIMARY AND SECONDARY OUTCOME MEASURES: Difficulty in ADL and IADL were the outcome variables. Descriptive statistics and bivariate analysis were carried out to present the preliminary results. Multivariate decomposition analysis was used to identify the contributions of covariates that explain the group differences to average predictions. RESULTS: There was a significant gender differential in difficulty in ADL (difference: 4.6%; p value<0.001) and IADL (difference: 17.3%; p value<0.001). The multivariate analysis also shows significant gender inequality in difficulty in ADL (coefficient: 0.046; p value<0.001) and IADL (coefficient: 0.051; p value<0.001). The majority of the gender gap in difficulty in ADL was accounted by the male-female difference in levels of work status (18%), formal education (15% contribution), marital status (13%), physical activity (9%), health status (8%) and chronic morbidity prevalence (5%), respectively. Equivalently, the major contributors to the gender gap in difficulty in IADL were the level of formal education (28% contribution), marital status (10%), alcohol consumption (9%), health status (4% contribution) and chronic morbidity prevalence (2% contribution). CONCLUSION: Due to the rapidly increasing ageing population, early detection and prevention of disability or preservation of daily functioning for older adults and women in particular should be the highest priority for physicians and health decision-makers.

Examining sex disparity in the association of waist circumference, waist-hip ratio and BMI with hypertension among older adults in India.

Hypertension is a public health issue touted as a "silent killer" worldwide. The present study aimed to explore the sex differential in the association of anthropometric measures including body mass index, waist circumference, and waist-hip ratio with hypertension among older adults in India. The study used data from the Longitudinal Aging Study in India (LASI) conducted during 2017-18. The sample contains 15,098 males and 16,366 females aged 60 years and above. Descriptive statistics (percentages) along with bivariate analysis were presented. Multivariable binary logistic regression analyses were used to examine the associations between the outcome variable (hypertension) and putative risk or protective factors. About 33.9% of males and 38.2% of females aged 60 years and above suffered from hypertension. After adjusting for the socioeconomic, demographic and health-behavioral factors, the odds of hypertension were 1.37 times (CI: 1.27-1.47), significantly higher among older adults who were obese or overweight than those with no overweight/obese condition. Older adults with high-risk waist circumference and waist-hip ratio had 1.16 times (CI: 1.08-1.25) and 1.42 times (CI: 1.32-1.51) higher odds of suffering from hypertension, respectively compared to their counterparts with no high-risk waist circumference or waist-hip ratio. The interaction effects showed that older females with overweight/obesity [OR: 0.84; CI: 0.61-0.74], high-risk waist circumference [OR: 0.89; CI: 0.78-0.99], and high-risk waist-hip ratio [OR: 0.90; CI: 0.83-0.97] had a lower chance of suffering from hypertension than their male counterparts with the similar anthropometric status. The findings suggested a larger magnitude of the association between obesity, high-risk waist circumference, high-risk waist-hip ratio and prevalent hypertension among older males than females. The study also highlights the importance of measuring obesity and central adiposity in older individuals and using such measures as screening tools for timely identification of hypertension.

Decomposing rural-urban differences in successful aging among older Indian adults.

The modernization and shift towards urbanized lifestyles have triggered several diseases, and the context of aging varies in urban and rural settings in India. The study aimed to investigate the urban-rural differences in successful ageing among older adults in India and the contributing factors in those differences. The study utilizes data from nationally representative Longitudinal Ageing Study in India (LASI, 2017-18). The analytical sample size for the study was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were carried out to present the initial results. Multivariable logistic regression and decomposition analysis was used to find the associations between explanatory variables and successful aging and to identify the contributions of covariates that explain the rural-urban differences in successful ageing. A proportion of 32% and 24% of older adults from rural and urban areas were successful agers with an urban disadvantage. Urban-dwelling older adults had 0.67 times [95% confidence interval (CI): (0.64, 0.71)] lower unadjusted odds of successful ageing than rural older adults. Again, after adjusting for the effect of other explanatory variables, urban older adults had 0.92 times [CI: (0.87, 0.98)] lower odds of being successful agers than their rural counterparts. The major contributors to the rural-urban inequality in successful aging were differences in regional distribution (17% contribution), waist circumference (16%), working status (16%), body mass index (13%) and physical activity (8%) among rural and urban older adults. The urban disadvantage in aging successfully may reflect the higher prevalence of adverse lifestyle behaviours in urban dwellers and under-diagnosis and under-reporting of many diseases in rural areas, particularly non-communicable diseases, suggesting the need for further investigation.

Association of family structure with gain and loss of household headship among older adults in India: Analysis of panel data.

BACKGROUND: Despite huge changes in demographic behaviors, the family continues to be the major source of psychosocial support for older adults in India. The loss of household headship can be a cause of disregard for the aged and is associated in a very fundamental way with other status losses. Our study used the two rounds of the India Human Development Survey to understand the association of family structure on the gain or loss status of household headship among 10,527 older adults. METHOD: Bivariate analysis was done using the chi-square test for association. Equivalently, the multivariate analysis involved estimating multivariable logistic regression models. Multicollinearity did not affect the estimates from the regression models. For examining headship transition, we performed two complete sets of analysis, by taking gain in headship and loss in headship as the outcome variable respectively. RESULTS: Across two rounds, a major shift in family structure was noticed as 6.8% of households moved from extended to a single generation. Results indicate that family structure was significantly associated with gaining and losing headship among older adults. Headship loss was more common among nuclear [OR: 2.16; CI: 1.28, 3.65] and extended [OR: 2.76; CI: 1.64, 4.66] family structures. Moreover, gaining headship was found to be significantly associated with married, educated, and working older adults. CONCLUSION: Since living in single generation household may preferably be encouraged among older adults than their living in a complex household without headship and value they deserve, the public intervention may support the independent living within the older population through housing policies that create additional choices presented to older adults making residential decisions.

Does lack of parental involvement affect school dropout among Indian adolescents? evidence from a panel study.

Despite the gross enrolment ratio of Indian children, being almost 91% in grades 6-8, the equivalently soaring rates of school dropout after 8th grade remains a huge concern for the policymakers. Researches from the developed countries and some developing countries have shown the benefits of parental involvement in their children's education in terms of reduced dropout rates. However, there is a stark absence of similar evidence in the Indian context. Our study examines whether the lack of parental involvement during primary schooling of Indian children eventually results in school dropout when the children become adolescents. We used IHDS panel data of children (8-11 years) in round-I who become adolescents (15-18 years) in round-II. Bivariate, multivariable and stratified analyses were performed using logistic regression models. The findings from the multivariable models show that children, whose parents did not -participate in PTA meetings, -discuss academic progress with schoolteacher and -supervise their children's homework in round-I respectively had 1.15 (95% CI: 1.01-1.30), 1.14 (95% CI: 1.01-1.29) and 1.17 (95% CI: 1.01-1.34) times higher risk of school dropout in round-II. Further, a similar relationship was observed when hypothesized relationship by gender, type of school attended and type of community of the children were examined. Among male children, parents' non-participation in PTA meetings was associated with 1.21 (95% CI: 1.02-1.44) times greater odds of school dropout. Children from private schools also had a 2.17 (95% CI: 1.42-3.32) times greater risk of dropout if their parents did not supervise their children in homework These findings highlight the crucial role of parental involvement in their children's primary education, in terms of reduced school dropout. The findings call for programmatic interventions that create awareness and encourage parental participation in their children's schooling.