Table 1 provides the sample characteristics of the study stratified by rural and urban places of residence. The sample comprised 54% of females and 46% of males. Around two-thirds of the respondents were from the rural area. Around three fourth of the individual were currently married and a similar proportion of the individuals were living with their spouses. Fifty-one percent of the respondents did not have any formal education and half of the eligible respondents were currently working. The sample comprised 45% of individuals from OBCs, 27% from 'others' caste, 19% & 9% from SC and ST respectively. The majority of the individuals had improved toilet facilities (73%) and improved sources of drinking water (94%). Around fifty-five percent of the households had a pucca house, and 17% had a kutcha house. A similar proportion of individuals came from various wealth quintiles. Sixty-three percent of the participants had never smoked and around 84% of the sample never consumed alcohol. Two-thirds of the participants were engaged in some sort of physical activity. Four percent of the respondents reported that disaster affected their health. The lowest proportion of the sample came from the north-eastern region (3%) followed by the Northern region while most participants were from the Southern region (24%).
Table 1
Background characteristics of the study population in India, LASI Wave-1, 2017–18
Variables | Rural | Urban |
Sample size (n) | Percentage (%) | Sample size (n) | Percentage (%) |
Demographic variables | | | | |
Sex | | | | |
Male | 20,324 | 46.70 | 10715 | 44.29 |
Female | 22,916 | 53.30 | 12651 | 55.71 |
Marital Status | | | | |
Currently married | 32,425 | 74.02 | 17130 | 71.90 |
Currently unmarried | 10,815 | 25.98 | 6236 | 28.10 |
Living arrangement | | | | |
Living alone | 1624 | 4.20 | 708 | 2.57 |
Living with spouse | 31,893 | 72.96 | 16745 | 70.97 |
Living with others | 9,723 | 22.85 | 5913 | 26.46 |
Age | | | | |
45–59 | 22,155 | 48.29 | 12549 | 52.99 |
60–69 | 12,652 | 30.28 | 6559 | 27.44 |
70–79 | 6,043 | 15.39 | 3207 | 14.68 |
80+ | 2390 | 6.03 | 1051 | 4.89 |
Socio-economic variables | | | | |
Years of schooling | | | | |
No Formal | 24,670 | 60.10 | 6683 | 30.00 |
1–5 years | 7,966 | 18.04 | 4205 | 15.77 |
6–9 years | 5,772 | 11.98 | 4752 | 18.39 |
More than 10 years | 4,832 | 9.88 | 7726 | 35.84 |
Working status | | | | |
Never worked | 10,484 | 22.09 | 8151 | 34.86 |
Currently working | 22,859 | 53.69 | 9708 | 41.82 |
Currently not working | 9,897 | 24.22 | 5507 | 23.32 |
Caste | | | | |
SC | 7,991 | 22.33 | 3023 | 12.24 |
ST | 9,082 | 11.06 | 2664 | 3.26 |
OBC | 16,368 | 43.72 | 8844 | 49.22 |
Others | 9,799 | 22.89 | 8835 | 35.28 |
Religion | | | | |
Hindu | 32,106 | 83.96 | 16605 | 77.60 |
Muslim | 4,087 | 9.53 | 3719 | 15.82 |
Christian | 4,674 | 2.92 | 1964 | 3.30 |
Others | 2373 | 3.59 | 1078 | 3.28 |
Type of toilet facility | | | | |
Unimproved | 11,618 | 36.54 | 894 | 5.06 |
Improved | 30,998 | 63.46 | 21807 | 94.94 |
Source of drinking water | | | | |
Unimproved | 2,375 | 5.17 | 1902 | 8.38 |
Improved | 40,245 | 94.83 | 20800 | 91.62 |
Type of house | | | | |
Pucca | 18,012 | 43.84 | 17332 | 79.90 |
Semi pucca | 14,025 | 33.89 | 4177 | 15.80 |
Kutcha | 10,498 | 22.28 | 1157 | 4.30 |
Wealth Index | | | | |
Poorest | 8,491 | 20.64 | 4690 | 21.34 |
Poorer | 8,664 | 21.87 | 4739 | 19.86 |
Middle | 8,711 | 20.89 | 4660 | 19.62 |
Richer | 8,721 | 19.46 | 4691 | 19.34 |
Richest | 8,653 | 17.14 | 4586 | 19.84 |
Health-related variables | | | | |
Smoking | | | | |
Never smoked | 25,207 | 57.37 | 16794 | 74.87 |
Ever smoked | 17,744 | 42.63 | 6279 | 25.13 |
Alcohol | | | | |
Never | 34,382 | 83.30 | 19808 | 88.39 |
Ever | 8,580 | 16.70 | 3274 | 11.61 |
Physical Activity | | | | |
Not engaged | 17,116 | 38.36 | 9947 | 37.88 |
Engaged | 26,124 | 61.64 | 13419 | 62.12 |
Disaster | | | | |
Not affected health | 41,488 | 95.22 | 22721 | 97.21 |
Affected health | 1,752 | 4.78 | 645 | 2.79 |
Endemic diseases | | | | |
No | 31,095 | 70.57 | 18794 | 81.23 |
Yes | 12,048 | 29.43 | 4458 | 18.77 |
Region | | | | |
North | 7,426 | 12.41 | 4,540 | 11.96 |
Central | 6,915 | 23.51 | 1992 | 14.16 |
East | 8,619 | 27.22 | 2961 | 14.29 |
Northeast | 7,130 | 4.09 | 2427 | 2.16 |
West | 4,570 | 13.71 | 4324 | 22.58 |
South | 8,580 | 19.06 | 7122 | 34.86 |
Total | 43,240 | 100.00 | 23,366 | 100.00 |
Table 2 presents the prevalence of the endemic disease by various socio-economic and demographic characteristics in the country. Chi-square tests indicated that demographic factors-sex, education; socio-economic variables such as working status, caste, religion, type of toilet facility, drinking water, wealth index, residence, region, and various health-related variables such as smoking, alcohol, physical activity, being affected by some disasters were significantly associated with having an endemic disease. Around a quarter of the respondents (26%) reported having experienced the endemic disease. Endemic disease prevalence was found to be higher in rural area (29%) than in urban areas (19%). The prevalence of endemic disease did not vary much by sex (26% for each sex). However, when categorized by place of residence, the prevalence was slight for women in rural areas and among men in urban areas. The prevalence of endemic disease was marginally higher for currently married respondents than currently unmarried/widowed/divorced etc. The endemic disease was more prevalent among households without improved toilet facilities and improved sources of drinking water. The highest prevalence of endemic disease was observed among individuals aged 80 and above (27%) while the lowest was observed among the age group 45–59 years (25%). Moreover, with the increase in educational status, the proportion of individuals with the endemic disease declined with the lowest prevalence observed among individuals with 10 or more years of schooling (20%). The prevalence was observed to be highest among 'kutcha' house dwellers, smokers, and alcohol users, engaged in physical activity, in the central region followed by the northern region. The prevalence of endemic disease was 48% among individuals whose health was affected by the disaster and 25% among those whose health was not affected by the disaster.
Table 2
Prevalence of endemic diseases among older adults by place of residence in India, LASI Wave 1, 2017–18
Variables | Rural | Urban |
Sample size(N) | % | p-value | Sample size(N) | % | p-value |
Demographic variables | | | | | | |
Sex | | | | | | |
Male | 5,547 | 28.9 | < 0.01 | 1,947 | 19.63 | < 0.01 |
Female | 6,501 | 29.89 | | 2,511 | 18.09 | |
Marital Status | | | | | | |
Currently married | 9,063 | 29.57 | > 0.10 | 3,246 | 19.65 | > 0.10 |
Currently unmarried | 2,985 | 29.02 | | 1,212 | 16.53 | |
Living arrangement | | | | | | |
Living alone | 414 | 28.12 | > 0.10 | 124 | 17.01 | > 0.10 |
Living with spouse | 8,923 | 29.54 | | 3,172 | 19.67 | |
Living with others | 2,711 | 29.31 | | 1,162 | 16.54 | |
Age | | | | | | |
45–59 | 6,092 | 28.84 | > 0.10 | 2,394 | 18.77 | > 0.10 |
60–69 | 3,610 | 29.86 | | 1,265 | 19.28 | |
70–79 | 1,698 | 29.56 | | 603 | 19.04 | |
80+ | 648 | 31.72 | | 196 | 15.14 | |
Socio-economic variables | | | | | | |
Years of schooling | | | | | | |
No Formal | 7,416 | 30.77 | < 0.01 | 1,553 | 22.6 | < 0.01 |
1–5 years | 2,156 | 29.02 | | 838 | 18.75 | |
6–9 years | 1,402 | 26.36 | | 826 | 16.71 | |
More than 10 years | 1,074 | 25.76 | | 1,241 | 16.58 | |
Working status | | | | | | |
Never worked | 2,714 | 29.71 | < 0.01 | 1,472 | 17.3 | < 0.01 |
Currently working | 6,435 | 28.51 | | 1,901 | 19.47 | |
Currently not working | 2,899 | 31.22 | | 1,085 | 19.73 | |
Caste | | | | | | |
SC | 2,299 | 29.68 | < 0.01 | 632 | 21.27 | < 0.01 |
ST | 2,619 | 32.14 | | 532 | 21.59 | |
OBC | 4,688 | 29.61 | | 1,612 | 17.25 | |
Others | 2,442 | 27.54 | | 1,682 | 19.72 | |
Religion | | | | | | |
Hindu | 9,412 | 29.84 | < 0.01 | 3,228 | 18.92 | < 0.01 |
Muslim | 1,004 | 29.04 | | 617 | 19.43 | |
Christian | 1,018 | 22.21 | | 374 | 9.35 | |
Others | 614 | 26.64 | | 239 | 21.6 | |
Type of toilet facility | | | | | | |
Unimproved | 4,020 | 34 | < 0.01 | 209 | 22.64 | < 0.01 |
Improved | 7,852 | 26.51 | | 4,121 | 19.04 | |
Source of drinking water | | | | | | |
Unimproved | 523 | 22.18 | < 0.01 | 362 | 19.56 | > 0.10 |
Improved | 11,351 | 29.81 | | 3,968 | 19.19 | |
Type of house | | | | | | |
Pucca | 4,775 | 28.12 | < 0.01 | 3,212 | 19.03 | < 0.01 |
Semi pucca | 3,853 | 29.11 | | 853 | 19.49 | |
Kutcha | 3,223 | 32.43 | | 259 | 21.61 | |
Wealth Index | | | | | | |
Poorest | 2,424 | 29.54 | < 0.01 | 905 | 20.32 | < 0.05 |
Poorer | 2,572 | 30.44 | | 976 | 21.08 | |
Middle | 2,442 | 29.11 | | 844 | 17.59 | |
Richer | 2,373 | 29.02 | | 875 | 16.69 | |
Richest | 2,237 | 28.87 | | 858 | 17.95 | |
Health-related variables | | | | | | |
Smoking | | | | | | |
Never smoked | 6,609 | 28.22 | < 0.01 | 2,975 | 17.46 | < 0.01 |
Ever smoked | 5,396 | 31.1 | | 1,444 | 22.49 | |
Alcohol | | | | | | |
Never | 9,425 | 29.38 | < 0.01 | 3,698 | 18.36 | < 0.01 |
Ever | 2,584 | 29.84 | | 724 | 21.45 | |
Physical Activity | | | | | | |
Not engaged | 4,541 | 28.4 | < 0.01 | 1,938 | 20.02 | < 0.10 |
Engaged | 7,507 | 30.07 | | 2,520 | 18.02 | |
Disaster | | | | | | |
Not affected health | 11,224 | 28.41 | < 0.01 | 4,300 | 18.57 | < 0.01 |
Affected health | 824 | 50.81 | | 158 | 29.57 | |
Region | | | | | | |
North | 2,408 | 37.93 | < 0.01 | 1,391 | 33.9 | < 0.01 |
Central | 3,132 | 43.9 | | 703 | 33.84 | |
East | 2,588 | 28.02 | | 462 | 20.04 | |
Northeast | 1,384 | 17.56 | | 521 | 15.92 | |
West | 1,288 | 24.01 | | 692 | 15.65 | |
South | 1,248 | 14.44 | | 689 | 8.92 | |
Total | 12,048 | 29.43 | | 4458 | 18.77 | |
Table 3 provides the odds ratios (ORs) of being affected by endemic disease, which was controlled for various background characteristics in the rural and urban areas separately. After controlling for older adults background characteristics, socio-economic variables, and behavioral factors, the ORs of having endemic disease among disaster-affected older adults was found to be uniformly higher in rural area [OR: 2.6 (2.2,3.0)] than in urban area [OR: 1.84 (1.4,2.5)]. The results from multivariate logistic regression analysis revealed that the OR of endemic disease among disaster-affected older adults in rural areas was 2.17 (CI: 1.9–2.5) and 1.42 in an urban area (CI: 1.02–1.97) in the adjusted model. Variables like sex, years of schooling, caste, religion, and region were found to be significantly associated with having an endemic disease. For example, the OR of having endemic disease among older adults females was 1.13 times in the rural area in the adjusted model. Similarly, higher educational attainment was found to act as a protective factor for endemic diseases in rural and urban areas. Rural residents, female sex, Christians, and individuals who were currently not working and with unimproved toilet facilities, were more vulnerable to endemic disease while urbanites, currently working, with improved water sources were at higher risk of having an endemic disease. Older adults who ever smoke, or engage in any physical activity and households in the richest wealth quintile also had a significantly higher likelihood of having an endemic disease in a rural area while these are insignificant in the case of urban residents. The eastern, north-eastern, western and southern parts of India have less chance of having the endemic disease as compared to the northern part of India. Moreover, urban people were less likely to have experienced endemic disease (0.81*** CI: 0.73–0.89).
Table 3
Results from the Logistic regression model showing factors associated with endemic diseases in India, LASI Wave 1, 2017-18
Endemic diseases | Rural | Urban |
Model-1 | Model-2 | Model-1 | Model-2 |
Disaster | | | | |
Not affected health® | | | | |
Affected health | 2.60*** [2.24,3.02] | 2.17***[1.87,2.52] | 1.84***[1.37,2.47] | 1.42* [1.02,1.97] |
Demographic Variable |
Sex | | | | |
Male® | | | | |
Female | | 1.13*[1.03,1.25] | | 1.13 [0.84,1.52] |
Marital Status | | | | |
Currently married® | | | | |
Currently unmarried | | 0.97[0.66,1.41] | | 0.99 [0.59,1.67] |
Living arrangement | | | | |
Living alone® | | | | |
Living with spouse | | 0.98[0.65,1.46] | | 1.18 [0.65,2.14] |
Living with others | | 0.98[0.81,1.18] | | 1.05 [0.69,1.57] |
Age | | | | |
45–59® | | | | |
60–69 | | 1.04[0.96,1.12] | | 1.04 [0.88,1.22] |
70–79 | | 1.01[0.90,1.13] | | 1.07 [0.87,1.33] |
80+ | | 1.13[0.95,1.35] | | 0.93 [0.69,1.26] |
Socio-economic variables |
Years of schooling | | | | |
No Formal® | | | | |
1–5 years | | 1.01[0.91,1.11] | | 0.82* [0.69,0.98] |
6–9 years | | 0.93[0.83,1.04] | | 0.76** [0.62,0.93] |
More than 10 years | | 0.87*[0.76,0.99] | | 0.74** [0.60,0.91] |
Working status | | | | |
Never worked® | | | | |
Currently working | | 1.04[0.94,1.15] | | 1.25* [1.02,1.52] |
Currently not working | | 1.15*[1.03,1.28] | | 1.17 [0.98,1.40] |
Caste | | | | |
Others® | | | | |
SC | | 1.08[0.97,1.21] | | 1.01 [0.83,1.21] |
ST | | 1.27***[1.12,1.45] | | 1.05 [0.76,1.46] |
OBC | | 1.25***[1.14,1.37] | | 1.27* [1.06,1.53] |
Religion | | | | |
Others® | | | | |
Hindu | | 1.32**[0.97,1.21] | | 1.09 [0.82,1.44] |
Muslim | | 1.23*[1.01,1.50] | | 1.02 [0.74,1.41] |
Christian | | 1.52**[1.18,1.95] | | 0.95 [0.54,1.65] |
Type of toilet facility | | | | |
Unimproved® | | | | |
Improved | | 0.83***[0.77,0.90] | | 0.9 [0.70,1.16] |
Source of drinking water | | | | |
Unimproved® | | | | |
Improved | | 0.95[0.81,1.10] | | 0.66** [0.49,0.89] |
Type of house | | | | |
Pucca® | | | | |
Semi pucca | | 1.05[0.97,1.14] | | 1.12 [0.94,1.35] |
Kutcha | | 1.09[0.09,0.99] | | 0.99 [0.74,1.34] |
Wealth Index | | | | |
Poorest® | | | | |
Poorer | | 1.11*[1,1.24] | | 1.1 [0.93,1.30] |
Middle | | 1.11[1,1.23] | | 0.93 [0.78,1.12] |
Richer | | 1.15*[1.03,1.29] | | 1.01 [0.83,1.22] |
Richest | | 1.25***[1.11,1.41] | | 1.26 [0.85,1.86] |
Health-related variables |
Smoking | | | | |
Never smoked® | | | | |
Ever smoked | | 1.12**[1.03,1.21] | | 1.08 [0.92,1.27] |
Alcohol | | | | |
Never® | | | | |
Ever | | 1.12[0.98,1.19] | | 1.01 [0.78,1.30] |
Physical Activity | | | | |
Not engaged® | | | | |
Engaged | | 1.19***[1.11,1.28] | | 1.16 [1.00,1.34] |
Region | | | | |
North® | | | | |
Central | | 1.06[0.96,1.17] | | 0.9 [0.77,1.06] |
East | | 0.54***[0.49,0.60] | | 0.44*** [0.37,0.53] |
Northeast | | 0.31***[0.28,0.35] | | 0.34*** [0.26,0.43] |
West | | 0.46***[0.41,0.52] | | 0.32*** [0.27,0.38] |
South | | 0.23***[0.20,0.25] | | 0.16*** [0.10,0.24] |
_cons | 0.40***[0.38,0.41] | 0.36***[0.22,0.58] | 0.23***[0.21,0.25] | 0.54[0.22,1.33] |
Note: ® Reference, * p < 0.05, ** p < 0.01, *** p < 0.001 |
The results of the Fairlie decomposition are presented in Table 4. The results indicate that only up to 69.09% variation in the prevalence of endemic diseases in rural-urban areas can be explained even after considering various important variables. It implies that some other factors still influence the prevalence of endemic diseases. The remaining unexplained percentage (30.91%) is considered a discrimination coefficient due to the group differences between rural and urban. Geographical regions and years of schooling contribute nearly 34% and 17% of the rural-urban inequality in the prevalence of endemic diseases among older adults. The contribution effect of each endowment shows that the highest difference in affected by the endemic disease in both groups is explained by region. This indicates that people from the urban area have an advantage in terms of lesser risk of having an endemic disease than their counterparts in the rural area. Similarly, years of schooling were also an important factor in determining the risk of endemic disease contributing to 17% of these rural-urban differences. Other factors contributing to this gap are smoking behavior, type of house facilities, caste categories, and disaster explaining around 6.4%, 6.9%,6.2%, and 4.2% of the rural-urban gap respectively. Thus, it is very evident that rural older adults are at higher risk of having an endemic disease than urban counterparts.
Table 4
Decomposition of the rural-urban gap in endemic disease in India, LASI Wave − 1, 2017-18
Variables | Coefficient | % |
Disaster | 0.0025254 | 4.15 |
Demographic variables | | |
Sex | -0.000789 | -1.29 |
Marital Status | 0.0002707 | 0.44 |
Living arrangement | -0.000253 | -0.42 |
Age | -0.000124 | -0.20 |
Socio-economic variables | | |
Years of schooling | 0.0102679 | 16.86 |
Working status | 0.0020283 | 3.33 |
Caste | 0.0038058 | 6.25 |
Religion | 0.0001735 | 0.28 |
Type of toilet facility | 0.0126527 | 20.77 |
Source of drinking water | 0.0000344 | 0.06 |
Type of house | 0.0041798 | 6.86 |
Wealth Index | 0.0001249 | 0.21 |
Health-related variables | | |
Smoking | 0.003896 | 6.40 |
Alcohol | 0.0010843 | 1.78 |
Physical Activity | 0.0003493 | 0.57 |
Region | 0.0206868 | 33.96 |
Total | 0.0609142 | 100 |
Difference (Rural-Urban) | 0.0881664 | |
Percent Explained | 69.09 | |
Percent Unexplained | 30.91 | |
Distribution of endemic diseases and percentage of individuals whose health was affected by the disaster at the State/UTs level
Figure one (a&b) show the variation in the rural-urban gap in the distribution of endemic diseases at the State/UTs level. While considering endemic diseases in rural areas, the highest value was observed in Dadra and Nagar Haveli (53.19%), followed by Chhattisgarh (50.21%) and Rajasthan (48.04%), while the lowest is observed in Lakshadweep (4.72%), followed by Nagaland (5.44%) and Kerala (8.82%). Furthermore, while considering endemic diseases in urban areas, Haryana (47.80%), followed by Bihar (41.71%) and Mizoram (41.61%), had the highest endemic diseases, while the lowest values were observed in Goa (4.51%) and Lakshadweep (7%).
Figure two (a&b) show the proportion of individuals whose health was affected by the disaster at the State/UTs level. In rural areas, the highest proportion of individuals with health affected by disaster was observed in Uttar Pradesh (9.24%), followed by Bihar (8.2%) and Madhya Pradesh (8.07%). On the other hand, Chandigarh and Delhi observed no cases where an individual's health was affected by a disaster. Furthermore, in urban areas, Sikkim (7.21%), followed by Bihar (6.54%) and Madhya Pradesh (6.38%), had the highest proportion of individuals with health affected by disaster, while the lowest was observed in Lakshadweep (0.44%) and Delhi (0.55%).