Equity and elderly health in India: reflections from 75th round National Sample Survey, 2017–18, amidst the COVID-19 pandemic

Abstract

Background Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) outbreak, called coronavirus disease - 2019 (COVID-19), has affected more than 200 countries across the globe with a higher fatality rate among the elderly population. Aim of the study is to highlight the vulnerability of the aged amidst the current COVID-19 pandemic, and in the light of the recent international evidence, suggests what government could do to mitigate their vulnerability. Methods Data from the recently released (November 2019) 75th Round National Sample Survey (NSS), which was conducted from July 2017 to June 2018, across 8077 rural villages and 6181 urban wards was used for this study. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232) included 42,762 elderly individuals (60 years or above). Bivariate and multivariate analyses were used for the calculation. Results Of the total sample of elderly individuals, 27.7% reported suffering from an ailment in the last 15 days, whereas 8.5% had been hospitalized during the last 365 days. Among the elderly, hospitalization rate was higher in the urban areas (OR: 1.23), general social category (OR: 1.18), richest economic quintile (OR: 1.69), and among those living alone (OR: 2.40). Also, among the elderly, 64% of those in the scheduled tribe (social group) and 51% in the poorest economic quintile utilized public facilities for hospitalization. Cardiovascular ailments were the major cause for hospitalization (18.1%) and outpatient visit (32%) among the elderly. Ailments related to diabetes and hypertension constituted 55% of outpatient visit for the elderly. Only 18.9% of the elderly had health insurance though chances of facing catastrophic health expenditures were high among the elderly. 6.6% of elderly female and 1.6% male live alone, and 27.5% of age 80 years and above are immobile. 50% of male and 90% of female are financially dependent on others and more so in poorer economic quintiles. Conclusions The vulnerability of India’s elderly increases across economic levels, and other dimensions such as the place of residence, gender, social group (caste), marital status, living arrangements, surviving children, and economic dependence. The current COVID-19 pandemic poses a greater risk of social isolation among the elderly, which may cause detrimental health impact. Trial registration Not applicable since the study is based on secondary data.

Differentials and predictors of hospitalization among the elderly people in India: Evidence from 75thround of National Sample Survey (2017-18)

“…Our study confirmed that the elderly living in urban residence and elderly males have shown higher hospitalization rate where these findings were consistent with previous research 11,17,[32][33][34][35]38 . Our results revealed that elderly women have lower odds of hospitalization than the elderly men and similar patterns of hospitalizations were also observed in other countries like-England 39 , Norway 17,40 , Italy 41 , but countries like Denmark 42 , Finnland 40 , South Korea 43 and Brazil 44 have shown higher hospitalization among older women than older men.…”

“…Our results revealed that elderly women have lower odds of hospitalization than the elderly men and similar patterns of hospitalizations were also observed in other countries like-England 39 , Norway 17,40 , Italy 41 , but countries like Denmark 42 , Finnland 40 , South Korea 43 and Brazil 44 have shown higher hospitalization among older women than older men. Interestingly, our study have showed that married elderly was found to be less likely to be hospitalized than unmarried, these finding are analogous to the other previous studies 11,35,[45][46][47][48] . Our study also confirmed that elderly living alone are more likely to be hospitalized than living with spouse or other than spouse and were also documented in other studies 35,[49][50][51][52][53] .…”

“…Interestingly, our study have showed that married elderly was found to be less likely to be hospitalized than unmarried, these finding are analogous to the other previous studies 11,35,[45][46][47][48] . Our study also confirmed that elderly living alone are more likely to be hospitalized than living with spouse or other than spouse and were also documented in other studies 35,[49][50][51][52][53] .…”

“…Our findings suggest that the overall hospitalization rates were lesser among the Indian elderly than in other countries like United States 28 , Brazil 29,30 , China 31 . The finding of this study has confirmed from the previous studies; old age people has been found to be higher hospitalization rate 11,17,[32][33][34][35] due to noncommunicable, which may be due to the timely policy formulation given the population ageing and drastic shifting of disease from communicable to non-communicable diseases 36,37 .…”

Determinants of rural-urban differential in healthcare utilization among the elderly population in India

“…The findings of this study are in tune with previous studies on health inequities [ 5 , 26 , 27 , 50 – 53 ] pertaining to both developed and developing countries that have affirmed the applicability of the social gradient hypothesis with findings suggesting that the level of health care utilisation is distributed along the social gradients. A number of studies have provided evidence that a person with lower level of educational attainment and income is less likely to have access to health care services and vice versa [ 54 – 56 ]. The present study confirms the same.…”