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) 75 th 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 555115 individuals (rural: 325232; urban: 229232) included that of 42762 elderly individuals (60 years or above). Bivariate and multivariate analysis was used for the calculation. Results: 27.7 % of elderly reported suffering from any ailment in the last 15 days, whereas 8.5% had hospitalization 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 class) and 51.0% in the poorest income quintile utilized public facilities for hospitalization. “Cardiovascular ailments” was a major cause for hospitalization (18.1%) and outpatient visit (32.0%) among the elderly. Diabetes and hypertension together constituted 55% of outpatient visit for the elderly. 18.9% of the elderly had health insurance though chances of facing catastrophic health expenditure was 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, 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.