Measuring the contributions of elderly and non-elderly age-groups to the disability burden in India: A Decomposition Analysis.

Abstract Background Disability has been an essential component of the health and development framework of India. Despite policy norms, a surge in disability across the population interrogates the role of the increasing elderly population in terms of chronic diseases led disabilities. The regional variation in demographic transitions possesses an unequal risk for the occurrence of disability in the population. The demographic and socio-economic factors can explain the inequality contributed by the elderly and non-elderly population. Methods We have used the National Sample Survey-76th round (2018) to measure the risk difference of disability between elderly and non-elderly age-groups across selected background characteristics. Fairlie’s decomposition technique has been adopted to measure the contribution made by the socio-economic factors in explaining the differences in the prevalence of disability. Distribution of states with respect to prevalence and risk difference of disability between elderly and non-elderly are plotted, to understand the regional inequality in the occurrence of disability in India. Results The study calculates a risk difference of 68 per 1000 population in India, explaining a higher risk of disability among the elderly that varies across socio-economic factors. Belonging from the Central region of India represents a higher risk of disability at old age (risk difference 76.8 per 1000 population) than the rest of the regions in India. Gender, marital status, and education explain 72 percent of the gap in the occurrence of disability between two broad age-groups. Despite having a similar disability prevalence, Kerala and Odisha have risk differences of 32 and 85 per 1000 population, respectively. Conclusions The gap in the disability prevalence is significantly explained by the marital status and educational status of the individuals. Disparity in the risk difference of disability among elderly and non-elderly across states suggests that large size of the elderly population is not the only reason for the increasing disability burden in India. Inadequate healthcare infrastructure and access also results into an unmet health care need pertaining to disability. Study suggests a policy relevance for disability-inclusive and geriatric centric healthcare and social supports in synchronisation with the demand realised by the states in India.