Caste Differences in Hypertension Among Women in India: Diminishing Health Returns to Socioeconomic Status for Lower Cas
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Caste Differences in Hypertension Among Women in India: Diminishing Health Returns to Socioeconomic Status for Lower Caste Groups Jalal Uddin 1
&
Sanjeev Acharya 2 & Jessica Valles 2 & Elizabeth H. Baker 2 & Verna M. Keith 2
Received: 2 October 2019 / Revised: 4 February 2020 / Accepted: 6 February 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Introduction The caste system is a relatively rigid system of social hierarchy in India. The caste membership defines one’s access to resources and life opportunities. A growing body of research suggests that lower caste groups have an excess burden of morbidity and mortality in India. However, it is not clear as to what extent caste differences in health are conditioned by socioeconomic status (SES) indicators. Purpose This study examined the caste differences in hypertension and tested whether caste differences in hypertension are conditioned by education and household wealth in a representative sample of women in India. Methods This study used data from the National Family Health Survey (NFHS) 2015–2016, India. The analysis is based on a nationally representative sample of 648,064 adult women aged 15–49 years. We used logistic regression to examine whether the association between caste and hypertension varied by education and wealth index using interactions and controlling for potential confounders. Results The regression models suggest that scheduled tribes and non-caste members have the highest odds of hypertension compared with privileged upper caste members. Interaction models indicate complex intersections of caste, education, and wealth index. The predicted probabilities derived from these interaction models suggest that while SES indicators are inversely associated with the odds of hypertension, the inverse patterning was significantly weaker in other backward classes and more protective in non-caste members compared with upper caste. Additionally, caste difference in predictive risk of hypertension tends to diverge at the lower levels of SES and become narrower at the higher levels of SES. Conclusions These findings provide evidence of differential returns to SES and have implications for understanding the causes of SES patterning in health among disadvantaged caste groups in India. Keywords Caste system . Hypertension disparity . Socioeconomic status . Intersectionality . India
Introduction Non-communicable diseases have surpassed infectious diseases as the leading cause of death in the global burden of disease (World Health Organization 2014). Hypertension is a
serious risk factor for many non-communicable diseases and has become a major global public health concern [1, 2]. Hypertension is not only a common risk factor for cardiovascular diseases (e.g., atherosclerosis, heart disease, heart failure, stroke, and angina) but also peripheral vascular disease,
* Jalal Uddin [email protected]
Verna M. Keith [email protected]
Sanjeev Acharya [email protected]
1
Department of Epidemiology, University of Alabama at Birmingham, 533B RPHB, 1665 University
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