O Paradoxo de Simpson: um estudo de caso demográfico sobre dinâmica da população, pobreza e desigualdade

Brazil is experiencing a demographic transition marked by regional inequalities. It is possible to assume that aspects related to poverty, development and inequality can reverse the association effects of the demographic transition indicators, typifying a phenomenon known as Simpson's Paradox. The aim of this study was to analyze the effect of inequality, poverty, and social development on the Brazilian population dynamics, verifying the occurrence of Simpson's paradox in the demographic transition. Population data from the Brazilian Demographic Censuses from 1991 to 2010 were used, according to age in Brazil and federation units. The correlation between demographic indicators was evaluated, stratifying the units of the federation into groups according to social indicators. There is an advance of UFs in relation to social indicators, although heterogeneity persists. The transition has been occurring in all FUs, with the distance between them persisting, even though it has been decreasing over the years. Simpson's paradox was observed when the analysis was carried out according to the census year, and according to the social indicator, mainly for the year 1991. The main challenge is to understand how the Brazilian demographic dynamics can be analyzed and to understand how the contextual factors change its rhythm, quantum, and pattern.O Brasil experimenta uma transição demográfica marcada por desigualdades regionais. É possível supor que aspectos relacionados à pobreza, desenvolvimento e desigualdade possam reverter os efeitos de associação dos indicadores da transição demográfica, tipificando um fenômeno conhecido como Paradoxo de Simpson. O objetivo deste estudo foi analisar o efeito da desigualdade, pobreza e desenvolvimento social na dinâmica populacional brasileira, verificando a ocorrência do paradoxo de Simpson na transição demográfica. Foram utilizados dados populacionais oriundos dos Censos Demográficos brasileiros de 1991 a 2010, segundo idade no Brasil e unidades da federação. Foi avaliada a correlação entre os indicadores demográficos, estratificando das unidades da federação em grupos de acordo com os indicadores sociais. Há um avanço das UF com relação aos indicadores sociais, ainda que persista a heterogeneidade. A transição vem ocorrendo em todas as UF, com persistência da distância entre elas, mesmo que com redução ao longo dos anos. Observou-se o paradoxo de Simpson quando a análise foi realizada segundo ano censitário, e segundo indicador social, principalmente para o ano de 1991. O principal desafio é compreender como a dinâmica demográfica brasileira pode ser analisada e compreender de que forma os fatores contextuais alteram seu ritmo, quantum e padrão

Coresidence increases the risk of testing positive for COVID-19 among older Brazilians

Background: Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact and thus potential infection. Methods: Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios), collected between July and November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians aged 60 years and older. We examine whether living arrangements influence self-reported COVID-19 symptoms as an indicator of subjective health assessment, testing as an indicator of health care service use, and a positive COVID-19 test result as an objective indicator of exposure to the disease. Results: Living arrangements shape older adults’ vulnerabilities to COVID-19 exposure and testing. Specifically, those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID- 19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skippedgeneration households. Conclusions: Overall, our findings suggest that coresidence with younger family members puts older adults’ health at risk in the context of COVID-19. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population

Assessing the impact of alcohol, tobacco and illegal drugs on miscarriage among pregnant women in São Paulo, Brazil

Prevalence of use and misuse of substances may be increasing during pregnancyin Brazil. We describe the patterns of consumption of alcohol, tobacco and illegal drugs amongpregnant women attending prenatal care service and explore whether there is a negative impactof these substances on the probability of having a miscarriage. Data from 133 women attendingprenatal care in the city of São Paulo, Brazil during 2010 and 2011 were analyzed. Women whoconsumed crack were 3.23 times more likely than pregnant users of alcohol and other drugs to havea miscarriage, even after controlling for marijuana use, age and educatio

Impact of the Chicago Earned Income Tax Periodic Payment intervention on food security

This article examines the Earned Income Tax Credit Periodic Payment Pilot and its effectiveness in reducing food insecurity for low-income households. Low-income families in Chicago who were eligible for the Earned Income Tax Credit provided data over four waves of data collection between 2014 and 2015. We utilize longitudinal random effects logit models to test the likelihood of experiencing food insecurity. The sample was composed mostly by women with low educational levels. The intervention significantly decreased the likelihood of experiencing food insecurity over time (T2: β=−0.23, p=.581; T3: β=−0.89, p < .10; T4: β=−2.21, p < .01). The Periodic Payment Pilot seems effective at reducing food insecurity in low-income families. Further research should examine how changes to the Earned Income Tax Credit payment distribution could improve the lives of low-income families, specifically concerning food insecurity.Ope

Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke

Background: The combined effect of diabetes and stroke on disability and mortality remains largely unexplored in Brazil and Latin America. Previous studies have been based primarily on data from developed countries. This study addresses the empirical gap by evaluating the combined impact of diabetes and stroke on disability and mortality in Brazil. Methods: The sample was drawn from two waves of the Survey on Health and Well-being of the Elderly, which followed 2,143 older adults in Sao Paulo, Brazil, from 2000 to 2006. Disability was assessed via measures of activities of daily living (ADL) limitations, severe ADL limitations, and receiving assistance to perform these activities. Logistic and multinomial regression models controlling for sociodemographic and health conditions were used to address the influence of diabetes and stroke on disability and mortality. Results: By itself, the presence of diabetes did not increase the risk of disability or the need for assistance; however, diabetes was related to increased risks when assessed in combination with stroke. After controlling for demographic, social and health conditions, individuals who had experienced stroke but not diabetes were 3.4 times more likely to have ADL limitations than those with neither condition (95% CI 2.26-5.04). This elevated risk more than doubled for those suffering from a combination of diabetes and stroke (OR 7.34, 95% CI 3.73-14.46). Similar effects from the combination of diabetes and stroke were observed for severe ADL limitations (OR 19.75, 95% CI 9.81-39.76) and receiving ADL assistance (OR 16.57, 95% CI 8.39-32.73). Over time, older adults who had experienced a stroke were at higher risk of remaining disabled (RRR 4.28, 95% CI 1.53, 11.95) and of mortality (RRR 3.42, 95% CI 1.65, 7.09). However, risks were even higher for those who had experienced both diabetes and stroke. Diabetes was associated with higher mortality. Conclusions: Findings indicate that a combined history of stroke and diabetes has a great impact on disability prevalence and mortality among older adults in Sao Paulo, Brazil.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (State of Sao Paulo Research Foundation, FAPESP) in BrazilBrazilian Ministry of HealthLemann Institute for Brazilian Studies at the University of Illinois at Urbana-Champaig

Randomized control trial of a childhood obesity prevention family-based program: “Abriendo Caminos” and effects on BMI

BackgroundHispanic individuals are at increased risk for obesity and other chronic health conditions. This article evaluates the effect of a family-based, childhood obesity primary prevention intervention in a community setting.MethodsA multi-site, randomized controlled trial community program with assessments at pre (T0), post-program (T1), and 6-months post-program (T2). Participating families were recruited from five sites. Only families of Mexican or Puerto Rican heritage with a least one child between 6 and 18 years were included in the study, without weight restrictions. Families were randomized to the intervention and control arms. Intervention families received six-2 h weekly workshops. Control families received printed generic nutrition and wellness information. Heights and weights were measured at the 3-time points to calculate BMI z-scores, BMI-percentiles, and weight status using age- and sex-specific growth charts, according to the CDC guidelines.ResultsThere were no differences in BMI-z scores between children in the intervention (n = 239) and control groups (n = 187) at T0. BMI z-scores decreased in the intervention group (−0.03, 95% CI, −0.066, −0.003, p = 0.032) at T1, but not in the control group at T1. Changes in BMI z-scores were not statistically significant at T2.ConclusionThe Abriendo Caminos intervention effectively prevented unhealthy weight gain in Hispanic children in the short-term, but not at 6-months post-intervention. Younger children and girls benefited more from the program at 6-months post-intervention. Additional efforts are needed to sustain long-term changes. Culturally-tailored programs can provide families with the knowledge to produce short-term changes and a potential pathway for sustainable changes in implementing healthy behaviors

Socioeconomic Inequalities in Oral Health-Related Quality of Life among Brazilians: A Cross-Sectional Study

Objective: Assess the magnitude of the socioeconomic inequalities related to the impact of oral health on quality of life among adults and elderly individuals. Methods: This was a cross-sectional study with data from the most recent oral health survey from the state of Minas Gerais, Brazil. The sample included data on 2288 individuals&#8212;1159 adults in the 35&#8211;44 age group and 1129 adults in the 65&#8211;74 age group. Socioeconomic inequalities in Oral Impacts on Daily Performance ratings were measured using two inequality measures: the slope index of inequality (SII) and the relative index of inequality (RII). Results: The prevalence of negative impact of oral health on quality of life was 42.2% for the total sample, 44.9% among adults and 37.5% among elderly individuals. Significant absolute and relative income inequalities were found for the total sample (SII &#8722;27.8; RII 0.52) and both age groups (adults: SII &#8722;32.4; RII 0.49; elderly: SII &#8722;18.3; RI 0.63), meaning that individuals in the lowest income level had the highest prevalence of negative impacts. Regarding schooling, no significant differences were observed among the elderly. Conclusion: There were significant socioeconomic inequalities related to the negative impact of oral health-related quality of life in Brazil among both age groups

Increasing educational inequalities in self-rated health in Brazil, 1998-2013

<div><p>The objectives of this study are to analyze the associations between educational levels and poor self-rated health (SRH) among adults in Brazil and to assess trends in the prevalence of poor self-rated health across educational groups between 1998 and 2013. Individual-level data came from the 1998, 2003 and 2008 Brazilian National Household Survey and the 2013 National Health Survey. We estimate prevalence rates of poor SRH by education. Using multivariable regressions, we assess the associations between educational levels and poor self-rated health. We use these regressions to predict the estimated ratios between the prevalence rates of those in low vs. high education in order to assess if relative changes in poor SRH have narrowed over time. Finally, we tested for statistically significant time trends in adult chronic disease inequalities by education. Results indicate a clear educational gradient in poor SRH. Prevalence ratios show that Brazilian adults with no education have levels of poor SRH that are 7 to 9 times higher than those with some college or more. The difference between those with lowest and highest education increased from 1998 to 2013. Compared to those with no education, there were increases in the prevalence of poor SRH among those with primary and secondary incomplete as well as among those with secondary complete in 2008 and 2013. In conclusion, there is a positive association between poor SRH and low education. Brazil has many social and geographic inequalities in health. Even though educational levels are increasing, there is no improvement in the general subjective health of Brazilians. Health inequalities by race and region highlight the need to improve the health of socially disadvantaged groups in Brazil. Addressing chronic conditions and mental health is needed to improve self-perceptions of health in Brazil as well.</p></div

Descriptive statistics, Brazil: 1998–2013.

<p>Descriptive statistics, Brazil: 1998–2013.</p

Age-adjusted prevalence rates of poor self-rated health, Brazil: 1998–2013.

<p>Age-adjusted prevalence rates of poor self-rated health, Brazil: 1998–2013.</p