India's NFHS-5 reported Under-Five Mortality Rate (U5MR) of 42 per 1000 live births. To assess inequality in this measure between richest and poorest quintiles, which analytic approach is most appropriate?

• A Absolute rate difference between richest and poorest quintile U5MR
• B Age-standardised death rate in each quintile
• C Cause-specific mortality fraction for the poorest quintile
• D Concentration Index, which summarises socioeconomic inequality across the full distribution ✓

Explanation

The Concentration Index (CI) quantifies health inequality across the entire socioeconomic distribution (not just extreme quintiles) and ranges from −1 (all inequality concentrated in the poorest) to +1 (concentrated in the richest), with CI = 0 indicating no inequality. Simple richest-poorest rate difference only captures two extremes and misses the gradient. Age-standardised rates and cause-specific fractions are descriptive measures, not inequality measures. CI is the standard WHO/World Bank metric for socioeconomic health inequality analysis.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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