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  • Title: How socioeconomic status affects birth and death rates in rural Kerala, India: results of a health study.
    Author: Kutty VR, Thankappan KR, Kannan KP, Aravindan KP.
    Journal: Int J Health Serv; 1993; 23(2):373-86. PubMed ID: 8500953.
    Abstract:
    Data relating to birth and death were collected from throughout the state of Kerala, India, in a health survey conducted by the Kerala Sastra Sahitya Parishad, a voluntary organization. In this study, the authors analyze birth and death rates as calculated from the sample of 9,940 households (57,665 persons), with respect to other variables such as region, religion, and socioeconomic status. In order to study the effect of socioeconomic factors on birth and death rates, a socioeconomic status rating (SES rating) was developed, taking into account such factors as income, education, housing conditions, and land ownership. Socioeconomic status was found to have a definite influence on birth and death rates, with higher socioeconomic status resulting in lower birth and death rates. This effect was independent of such confounding variables as age structure of the population, religion, and region. The higher risk of mortality among the poorer households can partly be explained by the material deprivation: the higher birth rates could be the result of poorer educational attainments. Data on births and deaths which occurred between July 1986 and June 1987 were obtained from a survey in all 1001 villages (9940 households and 57,665 persons) in Kerala state, India, by nongovernmental health activists. This study aims to examine the different patterns of mortality and fertility by income, education, religion, and region in order to understand the determinants of the health transition from high to low mortality and fertility. 80% of the study population resided in villages. Weights were assigned to the various characteristics on the basis of their value for understanding health status: income (0.35), education (0.25), housing type (0.25), and land (0.15). Four social classes (socioeconomic status [SES] groups) were used: 14% in the poorest class, 49% in the next poorest class, 29% in the middle class, and 8% in the highest class. The poor were not uniform in level of the four characteristics. Standardization of birth and death rates was performed for each SES group and community. Hindus made up 57% of the sample, of whom 9.8% were scheduled castes and 2.1% were scheduled tribes. 21.5% of the subjects were Christians, and 21% were Muslims. 28% of the scheduled castes were in the poorest SES group and 1% were in the highest SES group. The regional official crude birth rate was 22.3/1000 in rural areas. Crude death rates were 6.7/1000. The study rates were 23.6/1000 for births and 5.9/1000 for deaths. The highest birth and death rates unadjusted for age were in the lowest SES group. The rates were below the national figures. After age standardization, the SES differences in birth and death rates persisted and varied greatly between religious groups. SES differences in death rates were greatest in the under five-year age group.
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