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Hospitalisation trends in India from serial cross-sectional nationwide surveys: 1995 to 2014
  1. Anamika Pandey1,2,
  2. George B Ploubidis3,
  3. Lynda Clarke2,
  4. Lalit Dandona1,4
  1. 1Public Health Foundation of India, Gurugram, National Capital Region, India
  2. 2Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
  3. 3Centre for Longitudinal Studies, Department of Social Science, UCL- Institute of Education, University College London, UK
  4. 4Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  1. Correspondence to Anamika Pandey; anamika.pandey{at}


Objectives We report hospitalisation trends for different age groups across the states of India and for various disease groups, compare the hospitalisation trends among the older (aged 60 years or more) and the younger (aged under 60 years) population and quantify the factors that contribute to the change in hospitalisation rates of the older population over two decades.

Design Serial cross-sectional study.

Setting Nationally representative sample, India.

Data sources Three consecutive National Sample Surveys (NSS) on healthcare utilisation in 1995–1996, 2004 and 2014.

Participants Six hundred and thirty-three thousand four hundred and five individuals in NSS 1995–1996, 385 055 in NSS 2004 and 335 499 in NSS 2014.

Methods Descriptive statistics, multivariable analyses and a regression decomposition technique were used to attain the study objectives.

Result The annual hospitalisation rate per 1000 increased from 16.6 to 37.0 in India from 1995–1996 to 2014. The hospitalisation rate was about half in the less developed than the more developed states in 2014 (26.1 vs 48.6 per 1000). Poor people used more public than private hospitals; this differential was higher in the more developed (40.7% vs 22.9%) than the less developed (54.3% vs 40.1%) states in 2014. When compared with the younger population, the older population had a 3.6 times higher hospitalisation rate (109.9 vs 30.7) and a greater proportion of hospitalisation for non-communicable diseases (80.5% vs 56.7%) in 2014. Among the older population, hospitalisation rates were comparatively lower for females, poor and rural residents. Propensity change contributed to 86.5% of the increase in hospitalisation among the older population and compositional change contributed 9.3%.

Conclusion The older population in India has a much higher hospitalisation rate and has continuing greater socioeconomic differentials in hospitalisation rates. Specific policy focus on the requirements of the older population for hospital care in India is needed in light of the anticipated increase in their proportion in the population.

  • ageing
  • decomposition
  • hospitalization
  • non-communicable diseases
  • older population
  • propensity

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  • Contributors AP extracted the data, conducted statistical analysis, interpreted the findings and wrote the first draft of the manuscript. GBP contributed to the initial concept of the paper and guided the statistical analysis. LC provided critical comments on the manuscript for intellectual content. LD provided detailed guidance on the study design, analysis, interpretation of findings and drafting of the manuscript. All authors approved the final version of the manuscript.

  • Funding This work was supported by a Wellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a consortium of the UK universities. This research was part of Anamika Pandey’s doctoral study at the London School of Hygiene and Tropical Medicine.

  • Competing interests None declared.

  • Ethics approval Institutional ethics committees of the Public Health Foundation of India and the London School of Hygiene and Tropical Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors confirm that all data underlying the findings are fully available without restriction. Data are publicly available and can be obtained from the Ministry of Statistics and Programme Implementation, Government of India, New Delhi:

  • Correction notice This article has been corrected since it published Online First. Public Health Foundation of India has been added to Lalit Dandona’s affiliations.

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