Is socioeconomic segregation of the poor associated with higher premature mortality under the age of 60? A cross-sectional analysis of survey data in major Indian cities.
Is socioeconomic segregation of the poor associated with higher premature mortality under the age of 60? A cross-sectional analysis of survey data in major Indian cities.
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DOI：
10.1136/bmjopen-2017-018885
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发表时间：
2018-02-10
期刊：
影响因子：
2.9
通讯作者：
Bassanesi SL
中科院分区：
文献类型：
--
作者：
Chandola T;Mikkilineni S;Chandran A;Bandyopadhyay SK;Zhang N;Bassanesi SL
虽然城市化通常与低收入和中等收入国家的减贫有关，但它也导致穷人的社会经济隔离加剧。社会经济隔离程度较高的城市往往死亡率较高，尽管证据是基于生态关联的。本文研究了印度城市中穷人的社会经济隔离是否与60岁以下（“过早”）死亡风险较高有关，以及这种关联是否被背景和构成社会人口和社会经济因素所混淆。来自第三次（2008年）区级住户调查（DLHS-3）的人口代表性样本，来自生活在印度59个县（市）1876个城区的39427户家庭，超过100万人。结果是家庭在DLHS-3的前4年报告的任何60岁以下死亡。在区（市）一级估计的社会经济隔离是用穷人隔离指数和差异指数来衡量的。生活在穷人更孤立的城市的贫困家庭比生活在穷人不那么孤立的城市的贫困家庭过早死亡的可能性更高。相比之下，富裕家庭是否生活在社会经济隔离程度较高或较低的城市并不重要。隔离指数每增加1个标准差，与最贫困家庭过早死亡概率绝对增加1.1%相关。穷人日益隔离可能导致更高的过早死亡率。随着低收入和中等收入国家日益城市化，有可能导致穷人的隔离加剧以及过早死亡率增加。
Although urbanisation is generally associated with poverty reduction in low-income and middle-income countries, it also results in increased socioeconomic segregation of the poor. Cities with higher levels of socioeconomic segregation tend to have higher mortality rates, although the evidence is based on ecological associations. The paper examines whether socioeconomic segregation of the poor is associated with higher under-60 years (‘premature’) mortality risk in Indian cities and whether this association is confounded by contextual and compositional sociodemographic and socioeconomic factors. A population representative sample of over one million from 39 427 households living in 1876 urban wards within 59 Indian districts (cities) from the third (2008) District Level Household Survey (DLHS-3). The outcome was any death under the age of 60 reported by households in the preceding 4years of the DLHS-3. Socioeconomic segregation, estimated at the district (city) level, was measured using an isolation index of the poor and the index of dissimilarity. Poor households living in cities where the poor were more isolated had higher probabilities of premature mortality than poor households living in cities where the poor were less isolated. In contrast, it did not matter whether rich households lived in more or less socioeconomically segregated cities. A 1 SD increase in the isolation index was associated with an absolute increase of 1.1% in the probability of premature mortality for the poorest households. Increasing segregation of the poor may result in higher premature mortality. As low-income and middle-income countries become increasingly urbanised, there is a risk that this may lead to increased segregation of the poor as well as increased premature mortality.
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