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

Gender differences in healthy life expectancy among Brazilian elderly

BACKGROUND: This study examined gender differences in healthy life expectancy (HLE) and unhealthy life expectancy (UHLE) among people aged 60 years or older living in a large Brazilian city. METHODS: Based on Chiang method, abridged life tables were constructed for men and for women. To calculate HLE, the Sullivan method was applied. Estimates of the prevalence of self-rated health and self-reported functional disability (global, mild/moderate, and severe) were obtained from a population-based household survey carried out in 2008, which involved non-institutionalized individuals. RESULTS: Findings showed that women live longer and these extra years would be spent in good self-rated health. For example, women aged 60 would live, on average, 4 more years in good health in comparison to men. In terms of global limitations and mild/moderate limitations, no gender differences were detected for HLE. However, UHLE was statistically higher among women than among men at all ages in the global limitations and mild/moderate limitations (except for the age 80). Women at age 60, for instance, could expect to live 3.1 years longer with mild/moderate limitations compared to men. Gender differences were identified for severe limitations for either HLE or UHLE. In comparison to men, women at age 60, for example, would expect to live 2.5 and 2.0 more years without and with severe limitations. CONCLUSIONS: By showing that the advantage of longer life expectancy among women is not necessarily accompanied by worse health conditions, these findings add some evidence to the debate about male-female health-survival paradox. Policy efforts are necessary to reduce gender differences in the quantity and quality of years to be lived, providing equal opportunities to women and men live longer with quality of life, autonomy, and independence

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

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

ABSTRACT 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

Associations of sedentary behaviours and incidence of unhealthy diet during the COVID-19 quarantine in Brazil

Our aim was to analyse the association of change patterns on TV-viewing and computer/tablet use and incidence of elevated consumption of ultra-processed food consumption and lower consumption of fruits and vegetables during the COVID-19 pandemic. Data of 39 208 Brazilian adults from a Behaviour Web Survey were used. Unhealthy nutrition habits were eating fruits or vegetables for <5 d/week and ultra-processed food (sugary foods, snacks, ready-to-eat frozen foods and embedded foods) for ≥5 d/week. For incidence indicators, we only considered participants without unhealthy behaviour before the quarantine. We created four categories of change in TV-viewing and computer/tablet use, considering a cut-off point of 4 h/d for each behaviour (1 – consistently low, 2 – become low during the quarantine, 3 – become high during the quarantine or 4 – consistently high). Analyses were adjusted for sex, age group, highest academic achievement, per capita income, working status during the quarantine, skin colour and adherence to the quarantine.Logistic regression models revealed that high TV-viewing and computer/tablet use incidence were associated with higher odds for elevated frequency of ultra-processed food consumption (TV-viewing: OR 1·70; 95 % CI 1·37, 2·12; computer/tablet: OR 1·73; 95 % CI 1·31, 2·27) and low consumption of fruit and vegetables (TV-viewing: OR 1·70; 95 % CI 1·29, 2·23; computer/tablet: OR 1·53; 95 % CI 1·08, 2·17) incidence. Consistent high computer/tablet use also presented higher odds for incidence of elevated frequency of ultra-processed food consumption.Participants with incidence of sedentary behaviours were also more likely to present incidence of unhealthy diet during the COVID-19 pandemic quarantine243422426FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2019/24124-7; 308250/2017-6; 303241/2019-