Abstract
Objectives
This study analyzed the evolution of regional and socioeconomic inequality in life expectancy (LE) at birth and the probability of living up to 40 (LU40) and up to 60 years of age (LU60) in Brazilian municipalities between 1991 and 2010.
Methods
We analyzed data from the last three national census (1991, 2000 and 2010) computed for the 5565 Brazilian municipalities. They were divided into centiles according to the average per capita income. Poisson regression was performed to calculate the ratios between the poorest and the richest centiles.
Results
The average LE (+ 8.8 years), LU40 [6.7 percentage points (pp)] and LU60 increased (12.2 pp) between 1991 and 2010. The ratio of LE between the 1% of richest counties and the 1% of poorest counties decreased from 1.20 in 1991 to 1.09 in 2010. While in the poorest municipalities there was a gain of around 12 years of life, among the richest this increase was around 7 years.
Conclusions
There was a remarkable decrease in regional and socioeconomic inequality in LE, LU40 and LU60 in Brazil between 1991 and 2010.
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References
Barnish M, Tørnes M, Nelson-Horne B (2018) How much evidence is there that political factors are related to population health outcomes? An internationally comparative systematic review. BMJ Open. 8(10):e020886
Brasil (2010) Instituto Brasileiro de Geografia e Estatística. Síntese de Indicadores Sociais: uma análise das condições de vida da população brasileira 2010. IBGE, Rio de Janeiro
Brasil (2013) Instituto Brasileiro de Geografia e Estatística (IBGE). Tábuas abreviadas de mortalidade por sexo e faixa etária. IBGE, Brasília
Chetty R, Stepner M, Abraham S, Lin S, Scuderi B, Turner N, Bergeron A, Cutler D (2016) The association between income and life expectancy in the United States, 2001–2014. JAMA 315(16):1750–1766
dos Reis AAC (2018) What will be of Brazil and SUS? Rev Eletron Comun Inf Inov Saúde 12(2):119–124
Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Mackenbach JP, van Lenthe FJ, Mokdad AH, Murray CJL (2017) Inequalities in life expectancy among US counties, 1980 to 2014: temporal trends and keydrivers. JAMA Intern Med 177(7):1003–1011
Fukuda Y, Nakao H, Yahata Y, Imai H (2007) Are health inequalities increasing in Japan? The trends of 1955 to 2000. Biosci Trends 1(1):38–42
Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H et al (2016) Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 388(10058):2386–2402
Guanais FC (2015) The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998–2010. Am J Public Health 105(Suppl 4):S593–S599
Hone T, Rasella D, Barreto M, Atun R, Majeed A, Millett C (2017a) Large reductions in amenable mortality associated with Brazil’s primary care expansion and strong health governance. Health Aff (Millwood) 36(1):149–158
Hone T, Rasella D, Barreto ML, Majeed A, Millett C (2017b) Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: a national longitudinal analysis. PLoS Med 14(5):e1002306
Lustig N, Lopez-Calva LF, Ortiz-Juarez E (2012) Declining inequality in Latin America in the 2000s: the cases of Argentina, Brazil, and Mexico. World Bank, Washington
Macinko J, Dourado I, Aquino R, Bonolo PF, Lima-Costa MF, Medina MG, Mota E, de Oliveira VB, Turci MA (2010) Major expansion of primary care in Brazil linked to decline in unnecessary hospitalization. Health Aff (Millwood) 29(12):2149–2160
MacIntyre S, MacIver S, Sooman A (1993) Area, class and health: should we be focusing on places or people? J Soc Psychol 22(2):213–234
Martins AP, Monteiro CA (2016) Impact of the Bolsa Família program on food availability of low-income Brazilian families: a quasi experimental study. BMC Public Health 16(1):827
Massuda A, Hone T, Leles FAG, de Castro MC, Atun R (2018) The Brazilian health system at crossroads: progress, crisis and resilience. BMJ Glob Health 3(4):e000829
Melo FLB, Figueiredo A, Mineiro AS, Mendonça SEA (2012) Rescuing the minimum wage as a tool for development in Brazil. Int J Labour Res 4(1):27–44
Murphy M, Bobak M, Nicholson A, Rose R, Marmot M (2006) The widening gap in mortality by educational level in the Russian Federation, 1980–2001. Am J Public Health 96(7):1293–1299
Neri MC (2007) Pobreza e políticas sociais na década da redução da desigualdade. Nueva Sociedade 3:53–73
Nery JS, Pereira SM, Rasella D, Penna ML, Aquino R, Rodrigues LC, Barreto ML, Penna GO (2014) Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy. PLoS Negl Trop Dis 8(11):e3357
Nery JS, Rodrigues LC, Rasella D, Aquino R, Barreira D, Torrens AW, Boccia D, Penna GO, Penna MLF, Barreto ML, Pereira SM (2017) Effect of Brazil’s conditional cash transfer programme on tuberculosis incidence. Int J Tuberc Lung Dis 21(7):790–796
OECD (Organization for Economic Co-operation and Development) (2018) Life expectancy at birth (indicator). https://doi.org/10.1787/27e0fc9d-en. Accessed 17 Jan 2018
Oeppen J, Vaupel JW (2002) Broken limits to life expectancy. Science 296:1029
Östergren O, Martikainen P, Lundberg O (2018) The contribution of alcohol consumption and smoking to educational inequalities in life expectancy among Swedish men and women during 1991–2008. Int J Public Health 63(1):41–48
Paim J, Travassos C, Almeida C, Bahia L, Macinko J (2011) The Brazilian health system: history, advances, and challenges. Lancet 377(9779):1778–1797
Pearce J, Dorling D (2006) Increasing geographical inequalities in health in New Zealand, 1980–2001. Int J Epidemiol 35(3):597–603
Pochman M (2010) Social structure in Brazil: recent changes. Serv Soc Soc 104:637–649
Programa das Nações Unidas para o Desenvolvimento (PNUD) (2013) Instituto de Pesquisa Econômica Aplicada (Ipea), Fundação João Pinheiro (FJP). Atlas de Desenvolvimento Humano Formosa, PNUD, Ipea, FJP
Rasella D, Aquino R, Santos CA, Paes-Sousa R, Barreto ML (2013) Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities. Lancet 382(9886):57–64
Rasella D, Basu S, Hone T, Paes-Sousa R, Ocké-Reis CO, Millett C (2018) Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: a nationwide microsimulation study. PLoS Med 15(5):e1002570
Richardson EA, Pearce J, Mitchell R, Shortt NK, Tunstall H (2014) Have regional inequalities in life expectancy widened within the European Union between 1991 and 2008? Eur J Public Health 24(3):357–363
Riley JC (2005) Estimates of regional and global life expectancy, 1800–2001. Popul Dev Rev 31(3):537–543
Serrano F, Summa R (2012) Macroeconomic policy, growth and income distribution in the Brazilian economy in the 2000s. Investig Econ 71(282):55–92
Shei A, Costa F, Reis MG, Ko AI (2014) The impact of Brazil’s Bolsa Família conditional cash transfer program on children’s health care utilization and health outcomes. BMC Int Health Hum Rights 14:10
Son M, Cho Y, Oh J, Kawachi I, Yi J, Kwon S (2012) Social inequalities in life expectancy and mortality during the transition period of economic crisis (1993–2010) in Korea. Int J Equity Health 21(11):71
Spiteri J, von Brockdorff P (2019) Economic development and health outcomes: evidence from cardiovascular disease mortality in Europe. Soc Sci Med 30(224):37–44
Vaitsman J, Paes-Sousa R (2007) Avaliação de Políticas e Programas do MDS: Resultados: Bolsa Família e Assistência Social. MDS, Brasília
Wiesebron M (2014) Social policies during the Lula administration: the conditional cash transfer program Bolsa Família. In: de Castro F, Koonings K, Wiesebron M (eds) Brazil under the workers’ party. Palgrave Macmillan, London
World Health Organization (WHO) (2016) World health statistics: monitoring health for the SDGs, sustainable development goals. WHO, Geneva, p 2016
World Health Organization (WHO) (2017) World health statistics: monitoring health for the SDGs, sustainable development goals. World Health Organization, Geneva, p 2017
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Boing, A.F., Subramanian, S.V. & Boing, A.C. Reducing socioeconomic inequalities in life expectancy among municipalities: the Brazilian experience. Int J Public Health 64, 713–720 (2019). https://doi.org/10.1007/s00038-019-01244-x
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DOI: https://doi.org/10.1007/s00038-019-01244-x