Reduction of social inequalities in life expectancy in a city of Southeastern Brazil

<p>Abstract</p> <p>Background</p> <p>Around the world the life expectancy at birth has risen steadily over time. However, this increase in life years is not equally distributed among different social segments of the population. Studies have demonstrated that social groups living in deprived areas have a shorter life expectancy at birth in comparison to affluent ones. The aim of this study was to evaluate inequalities in life expectancy by socioeconomic strata in a city with one million inhabitants in Southeastern Brazil, in 2000 and 2005.</p> <p>Methods</p> <p>Through an ecological approach, the 49 areas of health care units of the city were classified into three socioeconomic strata, defined according to variables of income and educational level of the heads of household obtained from the 2000 Census. Life tables were constructed by sex for each of the three socioeconomic strata in 2000 and 2005.</p> <p>Results</p> <p>The life expectancy at birth for men and women living in poor areas was 6.9 and 5.5 years lower in comparison to the affluent ones in 2000. Between 2000 and 2005, these social inequalities in life expectancy at birth reduced, since the groups with lower socioeconomic level had gained more life years. The increase in life expectancy at birth experienced by areas with worse living conditions was 3 times higher than the increment estimated for prosperous areas for both sexes. Males had the greatest gain in life years, leading to a narrowing of gender differentials in life expectancy between 2000 and 2005.</p> <p>Conclusions</p> <p>The reduction of social inequalities in life expectancy suggests that living and health conditions have improved over time, due to social and health policies. The expansion of both health care coverage and cash transfer policies could have had positive effects on mortality reduction and on the consequent increase in the life expectancy, especially for the poor population.</p

Evolução e diferenciais socio-demograficos da mortalidade por cancer de colo de utero, mama feminina e prostata entre idosos no Estado de São Paulo de 1980 a 2000

Orientador: Tirza AidarDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias HumanasResumo: O cenário demográfico que se delineia no Estado de São Paulo é caracterizado pelo aumento envelhecimento relativo populacional e da participação relativa e das taxas de mortalidade por neoplasias malignas entre as causas de óbito. A estreita associação entre mortes por neoplasias malignas e a população idosa reforça a importância deste estudo, que apresenta como proposta investigar a relação entre as condições de vida dos idosos e a mortalidade por neoplasias de colo de útero, mama feminina e próstata para o Estado de São Paulo no ano de 2000. Parte-se do pressuposto que as desigualdades socioeconômicas se expressam nos diferenciais da mortalidade por neoplasias entre idosos e seu comportamento ao longo do tempo. Resgata-se as dimensões socioeconômicas e demográficas da mortalidade, numa tentativa de não se restringir à simples mensuração da desigualdade em saúde. Elege-se, como variáveis socioeconômicas para compor perfil socioeconômico dos idosos, os anos de estudo e rendimento domiciliar per capita, tendo como categorias de referência o analfabetismo funcional e o rendimento igual ou superior a 5 s.m. per capita. Para tanto, o Estado de São Paulo é dividido em Direções Regionais de Saúde (DIR) e a população idosa em grupos etários qüinqüenais e por sexo. Os anos censitários, que auxiliam a compreensão da evolução temporal, são 1980, 1991 e 2000. Através de análises de correlação e graus de dispersão, a dissertação aponta como resultados que: (1) ocorre um aumento mais significativo das taxas específicas de mortalidade por neoplasias entre idosos com idades mais avançadas no decorrer dos anos; (2) quanto maior a participação relativa do analfabetismo funcional entre os responsáveis pelo domicílio, menor são os riscos de morrer por neoplasias malignas; (3) quanto maior a proporção de domicílios com rendimento per capita igual ou superior a 5 s.m., maiores são as taxas específicas de mortalidade; (4) a localização e distribuição dos centros de saúde de alta complexidade, segundo as DIR¿s influem na magnitude das taxas; (5) as neoplasias de mama feminina e próstata apresentam maiores índices de correlação entre as taxas e as variáveis socioeconômicas, sendo que o comportamento de colo de útero seria mais aleatórioAbstract: There is a demographic scenery for the State of São Paulo (Brazil) characterized by population ageing and an increasing rate of death, among this population, caused by malignant neoplasms. Based on these findings, this study intends to investigate the relation between socioeconomics and demographic pointers and mortality by malignant neoplasms ¿ uterine cervical, feminine breast and prostate ¿ among the aged population of the State of São Paulo and its health regional services during the year of 2000. Presuming that the socioeconomics inequalities are expressed in the mortality rates by malignant neoplasms among aged people, it was elected as variables to compose the socioeconomic profiles, schooling and per capita domicile income. The reference categories are determined as functional illiteracy and the income of 5 minimal salaries or above per capita. The State of São Paulo is divided by the ¿regional health services¿ (DIR) and the aged population by sex in 5-aged groups. The census years which helps to understand the time evolution are 1980, 1991 and 2000. Through descriptive analysis as well as linear models adjusts, the results suggest that: (1) there is a significative increase in the mortality rates by malignant neoplasms among the eldest and this tendency does not present a homogeneity aspect among the DIR¿s; (2) the rate of mortality due to feminine breast and prostata cancers is, unexpectedly, higher in the more developed regions; (3) in areas with health centers of high complexity for cancer treatment, the same tendency occurs, i.e. the highest levels of deaths as a consequence of neoplasms in aged population were observed.MestradoSaude e Morbi-mortalidadeMestre em Demografi

Mortality among adults: gender and socioeconomic differences in a Brazilian city

<p>Abstract</p> <p>Background</p> <p>Population groups living in deprived areas are more exposed to several risk factors for diseases and injuries and die prematurely when compared with their better-off counterparts. The strength and patterning of the relationships between socioeconomic status and mortality differ depending on age, gender, and diseases or injuries. The objective of this study was to identify the magnitude of social differences in mortality among adult residents in a city of one million people in Southeastern Brazil in 2004-2008.</p> <p>Methods</p> <p>Forty-nine health care unit areas were classified into three homogeneous strata using 2000 Census small-area socioeconomic indicators. Mortality rates by age group, sex, and cause of death were calculated for each socioeconomic stratum. Mortality rate ratios (RR) and 95% confidence intervals were estimated for the low and middle socioeconomic strata compared with the high stratum.</p> <p>Results</p> <p>In general, age-specific mortality rates showed a social gradient of increasing risks of death with decreasing socioeconomic status. The highest mortality rate ratios between low and high strata were observed in the 30-39 age group for males (RR = 1.74, 95% CI 1.59-1.89), and females (RR = 1.90, 95% CI 1.65-2.15). Concerning specific diseases and injuries, the greatest inequalities between low and high strata were found for homicides (RR = 2.44, 95% CI 2.27-2.61) and traffic accidents (RR = 1.64, 95% CI 1.45-1.83) among males. For women, the highest inequalities between the low and high strata were for chronic respiratory diseases (RR = 2.19, 95% CI 1.94-2.45) and acute myocardial infarction (RR = 1.93, 95% CI 1.79-2.07). Only breast cancer showed a reversed social gradient (RR = 0.70, 95% CI 0.48-0.92). Inequalities in circulatory and respiratory diseases mortality were greater among females than among males.</p> <p>Conclusions</p> <p>Substandard living conditions are related to unhealthy behaviors, as well as difficulties in accessing health care. Therefore, the Brazilian Health System (SUS) must ensure greater access to primary and hospital care, and develop programs that promote healthier lifestyles among vulnerable groups to reduce social inequalities in mortality. Moreover, because deaths from external causes are concentrated in poor areas, cooperative and coordinated intersectoral actions should be taken to combat the deadly violence cycle.</p

Happy life expectancy among older adults: differences by sex and functional limitations

OBJECTIVE To evaluate if the happy life expectancy in older adults differs according to sex and functional limitations. METHODS Life expectancy was estimated by Chiang method, and happy life expectancy was estimated by Sullivan method, combining mortality data with the prevalence of happiness. The questions on happiness and limitations came from a health survey, which interviewed 1,514 non-institutionalized older adults living in the city of Campinas, SP, Southeastern Brazil. The happy life expectancy was estimated by sex, age, and functional limitations. Based on the variance and standard error of the happy life expectancy, we estimated 95% confidence intervals, which allowed us to compare the statistical differences of the number of happy years lived among men and women. RESULTS Differences by sex in happy life expectancy were significant at ages 60, 65, and 70. In absolute terms, women live more years happily. But, in relative terms, older men could expect to live proportionally more years with happiness. Happy life expectancy decreased significantly with increasing age in both men and women. Among older people living without functional limitation, differences by sex were statistically significant in all age groups, except at age 80. In the group with limitations, no significant differences by sex were found. Significant differences between the group without and with functional limitations were seen in both men and women. CONCLUSIONS Older men could expect to live a greater proportion of their lives happily in comparison to same-aged women, but women show more years with happiness than men. Functional limitations have a significant impact on happy life expectancy for both sexes

[emergency Care For Victims Of Violence And Accidents: Differences In The Epidemiological Profile Between The Public And Private Health Services. Viva--campinas, São Paulo, Brazil, 2009].

The scope of this study is to analyze the differences in the profile of emergency care for external causes between public and private emergency departments. With data come from VIVA-Campinas 2009, the association between the nature of healthcare and the characteristics of the victims was verified using the chi-square test. Using Poisson regression, proportion ratios of care in the public and private network were estimated. In the sample of 1094 victims, 67.8% were treated by public health. Traffic accidents, animal-related accidents, and assaults were 2 times higher in public units, whereas collisions with objects and sprains were 75% and 2.7 times higher in private units. Cranium-encephalic trauma/polytrauma and cuts/lacerations were 3.8 times and 61% more frequent in public care, while victims with no injuries, with dislocations/sprains or fractures being predominant in private care. Head and multiple organ injuries, road accident and work-related injuries, the use of public transport or mobile emergency care services/ambulances were predominant in public care. Revealing significant differences in care in public and private care can contribute to the organization of healthcare.172279-9

Emergency care for victims of violence and accidents: differences in the epidemiological profile between the public and private health services. VIVA - Campinas, São Paulo, Brazil, 2009

The scope of this study is to analyze the differences in the profile of emergency care for external causes between public and private emergency departments. With data come from VIVA-Campinas 2009, the association between the nature of healthcare and the characteristics of the victims was verified using the chi-square test. Using Poisson regression, proportion ratios of care in the public and private network were estimated. In the sample of 1094 victims, 67.8% were treated by public health. Traffic accidents, animal-related accidents, and assaults were 2 times higher in public units, whereas collisions with objects and sprains were 75% and 2.7 times higher in private units. Cranium-encephalic trauma/polytrauma and cuts/lacerations were 3.8 times and 61% more frequent in public care, while victims with no injuries, with dislocations/sprains or fractures being predominant in private care. Head and multiple organ injuries, road accident and work-related injuries, the use of public transport or mobile emergency care services/ambulances were predominant in public care. Revealing significant differences in care in public and private care can contribute to the organization of healthcare.O objetivo deste estudo foi analisar as diferenças no perfil dos atendimentos de emergência por causas externas, entre as unidades de saúde públicas/conveniadas ao SUS e as privadas. Com dados do VIVA-Campinas 2009, foi verificada a associação entre natureza do serviço de saúde e características das vítimas, evento e atendimento usando teste qui-quadrado. A partir da regressão de Poisson, foram estimadas as razões entre a proporção de atendimentos da rede pública e da privada. O setor público respondeu por 67,8% dos atendimentos na amostra de 1094 vítimas. Acidentes de transportes, acidentes com animais e agressões foram 2 vezes mais frequentes nas unidades públicas; já choques contra objeto e entorses foram 75% e 2,7 vezes superiores nas privadas. Traumatismos crânio-encefálicos/politraumatismos e cortes/lacerações foram 3,8 vezes e 61% mais frequentes no setor público, enquanto ocorrências sem lesão física, com luxações/entorses ou fraturas predominaram no privado. Vítimas com lesões na cabeça e em múltiplos órgãos, ocorrências em vias públicas, eventos relacionados ao trabalho, uso de transportes coletivos e SAMU/resgate/ambulâncias prevaleceram na rede pública. O estudo, ao apontar significativas diferenças entre os eventos atendidos na rede pública e privada, pode contribuir na organização da assistência à saúde.22792290Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Quality of life of smokers and its correlation with smoke load

O tabagismo é considerado uma doença crônica e uma das principais causas de mortes evitáveis no mundo. A qualidade de vida é uma importante medida de impacto na saúde e em sua relação com os níveis de dependência de nicotina e de carga tabagística, os quais ainda não estão totalmente esclarecidos. Avaliou-se a qualidade de vida de tabagistas e sua correlação com a carga tabagística e com o nível de dependência nicotínica. Foram inclusos, neste estudo, tabagistas de ambos os sexos e sem doenças clínicas diagnosticadas. Posteriormente, foi realizada avaliação da qualidade de vida e nível de dependência nicotínica por meio de questionários. A amostra foi constituída por 48 indivíduos. Houve correlação negativa entre a vitalidade e a quantidade de anos em que estes indivíduos fumaram (p=0,009; r=-0,27), assim como o estado geral de saúde e anos/maço (p=0,02; r=-0,23) e quantidade de cigarros consumidos por dia atualmente (p=0,006; r=-0,29). É possível observar correlação negativa entre capacidade funcional e a pontuação do questionário de Fagerström (p=0,004; r=-0,3). Concluiu-se que a carga tabagística e o grau de dependência de nicotina apresentaram relação com piores índices de qualidade de vida da população tabagista.El tabaquismo es considerado una enfermedad crónica y una de las principales causas de muertes evitables en el mundo. La cualidad de vida es una importante medida de impacto en la salud y en su relación con los niveles de dependencia de nicotina y de carga de tabacos, los cuales todavía no están totalmente aclarados. Se evaluó la cualidad de vida de consumidores de tabaco y su correlación con la carga de tabacos y con el nivel de dependencia nicotínica. Fueron inclusos, en este estudio, consumidores de tabacos de ambos sexos y sin enfermedades clínicas diagnosticadas. Posteriormente, fue realizada la evaluación de la cualidad de vida y el nivel de dependencia nicotínica por medio de cuestionarios. La muestra fue constituida por 48 individuos. Hubo correlación negativa entre la vitalidad y la cuantidad de años en que estos individuos fumaron (p=0,009; r=-0,27), así como el estado general de salud y años/cajetilla (p=0,02; r=-0,23) y la cuantidad de cigarrillos consumidos al día actualmente (p=0,006; r=-0,29). Es posible observar correlación negativa entre la capacidad funcional y el puntaje del cuestionario de Fagerström (p=0,004; r=-0,3). Se concluyó que la carga de tabacos y el grado de dependencia de nicotina presentaron relación con los peores índices de cualidad de vida de la población consumidora de tabacos.Smoking is considered a chronic disease and one of the leading causes of preventable death in the world. The quality of life is an important measure of health impact and its correlation with nicotine dependence levels and smoking is unclear. We evaluated the quality of life of smokers and its correlation with smoke load and the nicotine dependence level. Smokers of both sexes and with no diagnosis of clinical diseases were included in this study. We evaluated their quality of life and level of nicotine dependence through questionnaires. The sample consisted of 48 individuals, 27 women and 21 men. There was a negative correlation between vitality and the amount of years these individuals have smoked (p=0.009;r=-0.27), as well as the general health condition and pack/years (p=0.02; r=-0.23), and the current amount of cigarettes consumed per day (p=0.006;r=-0.29). We can also observe a negative correlation between functional capacity and the Fagerström questionnaire score (p=0.004;r=-0.3). We concluded that the smoke load and the nicotine dependence levels were related to worse quality of life indices of the smoking population

Self-reported diabetes in the elderly: prevalence, associated factors, and control practices

O objetivo do estudo foi avaliar a prevalência de diabetes auto-referido em idosos, identificando fatores associados, conhecimento e práticas quanto às opções de tratamento. Trata-se de estudo transversal de base populacional, com amostra estratificada por conglomerados e em dois estágios, em municípios do Estado de São Paulo, Brasil. Dos 1.949 idosos, 15,4% referiram diabetes. O índice de massa corporal e a prática de exercício físico estiveram associados à doença. Houve diferença entre diabéticos e não diabéticos quanto à auto-avaliação da saúde, internação, morbidade auto-referida nos últimos 15 dias, e relato das seguintes doenças: hipertensão, anemia, doença renal e cardiovascular. Não houve desigualdade em relação à renda familiar per capita quanto à visita ao médico/serviço de saúde, à participação em grupos de discussão e às práticas de controle da doença. O estudo sugere a importância de mudanças comportamentais, como estratégias de prevenção e controle da doença e suas complicações, bem como a necessidade de oferta de intervenções educativas com ampliação da cobertura de cuidados aos diabéticos261175184The aim of the study was to assess the prevalence of self-reported diabetes in the elderly, identifying associated factors, knowledge, and practices related to treatment options. This was a cross-sectional population-based study with stratified clustered two-stage sampling in six municipalities in the State of São Paulo, Brazil. Among the 1,949 elderly, 15.4% presented self-reported diabetes. Body mass index and exercising were statistically associated with diabetes. There was a significant difference between diabetics and non-diabetics in terms of self-rated health, hospitalization, self-reported illness in the previous two weeks, and report of the following diseases: hypertension, anemia, chronic kidney disease, and heart disease. In terms of per capita family income, there was no difference in regular medical visits, participation in discussion groups, and control practices. The findings show the need for behavior changes to prevent and control diabetes and its complications. Educational interventions are needed to expand the coverage of diabetes car