标题： 揭开不平等的面纱：马哈拉施特拉邦和印度健康结果的社会经济决定因素与性别差异——来自NFHS-5的见解 显示英文标题

标题： Unmasking inequility: socio-economic determinants and gender disparities in Maharashtra and India's health outcomes -- Insights from NFHS-5

摘要： 本研究考察了印度长期存在的健康不平等挑战，偏离了通常关注总体死亡率改善的常规做法。尽管自独立以来印度在整体健康指标上取得了进展，但健康结果的分布仍然不均，这一点在新冠疫情期间得到了鲜明的凸显。本研究利用2019-20年《国家家庭与健康调查》（NFHS-5）的数据，探讨社会经济因素对健康差异的影响，重点分析了全国和各州层面的情况，特别是针对马哈拉施特拉邦。采用健康经济学框架，研究深入分析了个人层面数据、人口比例、自我报告的疾病患病率以及不同社会经济群体中的治疗模式。按性别分层的回归分析被用来量化社会经济因素对报告患病率的影响。此外，还使用了Fairlie分解法——Oaxaca分解法的扩展形式，来剖析发病率的性别差距，评估观察到的差异在多大程度上归因于解释变量。研究结果显示，自我报告的患病负担显著，印度约九分之一的人口和马哈拉施特拉邦约八分之一的人口报告有患病情况。值得注意的是，女性的发病率几乎是男性的两倍。分解分析确定了性别差异的关键驱动因素。在印度，婚姻状况加剧了这些差异，而保险覆盖率、种姓、城市居住和财富则缓解了这些差异。在马哈拉施特拉邦，城市居住和婚姻状况扩大了差距，而宗教、种姓和保险覆盖率缩小了差距。本研究强调了有针对性的政策干预的重要性，以应对推动印度健康不平等的社会经济因素的复杂相互作用。 显示英文摘要

摘要： This research examines the persistent challenge of health inequalities in India, departing from the conventional focus on aggregate improvements in mortality rates. While India has achieved progress in overall health indicators since independence, the distribution of health outcomes remains uneven, a fact starkly highlighted by the COVID-19 pandemic. This study investigates the socio-economic determinants of health disparities using the National Family and Health Survey (NFHS)-5 data from 2019-20, focusing on both national and state-level analyses, specifically for Maharashtra. Employing a health economics framework, the analysis delves into individual-level data, population shares, self-reported morbidity prevalence, and treatment patterns across diverse socio-economic groups. Regression analyses, stratified by gender, are conducted to quantify the impact of socio-economic factors on reported morbidity. Furthermore, a Fairlie decomposition, an extension of the Oaxaca decomposition, is utilised to dissect the gender gap in morbidity, assessing the extent to which observed differences are attributable to explanatory variables. The findings reveal a significant burden of self-reported morbidity, with approximately one in nine individuals in India and one in eight in Maharashtra reporting morbidity. Notably, women exhibit nearly double the morbidity rate compared to men. The decomposition analysis identifies key drivers of gender disparities. In India, marital status exacerbates these differences, while insurance coverage, caste, urban residence, and wealth mitigate them. In Maharashtra, urban residence and marital status widen the gap, whereas religion, caste, and insurance coverage narrow it. This research underscores the importance of targeted policy interventions to address the complex interplay of socio-economic factors driving health inequalities in India.