Lifespan extension with varying cause-of-death trajectories

Abstract

Neonatal and under-five mortality rate in Indian districts with reference to Sustainable Development Goal 3

Jayanta Kumar Bora 
Nandita Saikia

Background and objective: India contribute the highest global share of deaths among the under-fives. Continuous monitoring of the reduction in the under-five mortality rate (U5MR) at local level is thus essential to set priorities for policy-makers and health professionals. In this study, we aimed to provide an update on district-level disparities in the neonatal mortality rate (NMR) and the U5MR with special reference to Sustainable Development Goal 3 (SDG3) on preventable deaths among new-borns and children under five. 

Data and methods: We used recently released population-based cross-sectional data from the National Family Health Survey (NFHS) conducted in 2015–2016. We used the synthetic cohort probability approach to analyze the full birth history information of women aged 15–49  to estimate the NMR and U5MR for the ten years preceding the survey.

Results: Both the NMR and U5MR  vary enormously across Indian districts. With respect to the SDG3 target for 2030 for the NMR and the U5MR, the estimated NMR for India for the period studied is about 2.4 times higher, while the estimated U5MR is about double. At district level, while 9% of the districts have already reached the NMR targeted in SDG3, nearly half (315 districts) are not likely to achieve the 2030 target even if they realize the NMR reductions achieved by their own states between the last two rounds of National Family Health Survey of India. Similarly, less than one-third of the districts (177) of India are unlikely to achieve the SDG3 target on the U5MR by 2030.  While the majority of  high-risk districts for the NMR and U5MR are located in the poorer states of north-central and eastern India, a few high-risk districts for NMR also fall in the rich and advanced states. About 97% of districts from Chhattisgarh and Uttar Pradesh, for example, are unlikely to meet the SDG3 target for preventable deaths among new-borns and children under age five, irrespective of gender.

Conclusions: To achieve the SDG3 target on preventable deaths by 2030, the majority of Indian districts clearly need to make a giant leap to reduce their NMR and U5MR.

Abstract

Socio-economic patterns and determinants of adult deaths due to external-cause in India: Analysis of nationally representative population-based survey data
Nandita Saikia, Vladimir Shkolnikov, Domantas Jasilionis, Moradhvaj

Objective: To analyze the pattern and risk factors of all-cause and external-cause mortality among adults in India.

Data and method: Using nationally representative population based survey, known as National Family Health Survey, 2015-2016, we calculated age specific death rates among adults aged 15-64 for all-cause and external-cause in three years prior to the survey. We estimated the cause eliminated life expectancy due to external-cause of death by sex. Further, we did logistic regression analysis to investigate the socio-economic determinants of all-cause and external-cause mortality in India.

Results: Male disadvantage in external-cause mortality is higher than all-cause mortality as male external-cause mortality is about 2.24 times higher than that of female (male:10.10 vs female:4.50 per 10,000). 21,340 overall adult deaths yielded 2,898 (22.03% of total male deaths) and 1,128 (13.78% of total female deaths) external deaths among men and women respectively. For all-cause mortality, caste and household wealth quintile (WQ) are significant determinants for both sexes. Caste is not a significant determinant of external-cause mortality except for Scheduled Caste males. Hindus experience excess external-cause mortality (adjusted odds ratio (aOR) men: 1.21, CI:1.00-1.46 Vs women: 1.35, CI: 1.02-1.78). Rural excess mortality in all-cause mortality reverses (aOR men: 0.80, CI: 0.76-0.85) and become insignificant in external-cause mortality for both sexes. Finally, the risk of external deaths elevates as household WQ reduces from the richest to the poorest category (aOR for poorest WQ male: 2.24, CI: 1.82-2.75; female: 1.84, CI:1.34:2.54).

Conclusion: Share of external deaths to total deaths in India is higher than previously estimated. The people belonging to lower socio-economic strata carry the burden disproportionately.