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308075
Social inequalities trends in a large Brazilian city: Physical and social environments, health conditions and healthcare services use
Monday, November 17, 2014
Luciana de Souza Braga
,
Programa de Pós-graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Maria Fernanda Lima-Costa, MD, PhD
,
Oswaldo Cruz Foundation, Centro de Pesquisas, Rene Rachou, Belo Horizonte, Brazil
Cibele Comini César, PhD
,
Departamento de Estatística, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
James Macinko, PhD
,
Department of Nutrition, Food Studies, Public Health, New York University, New York, NY
This study assessed trends in social inequalities among individuals aged 60 years or older, living in Belo Horizonte, a large Brazilian city, in four domains of the WHO Active Ageing Model: physical environment, social environment, health conditions and healthcare services use. Data came from two representative household surveys conducted in 2003 and 2010 and include 2,624 people (n=1,149 in 2003 and n=1,475 in 2010). Socioeconomic inequality was measured using the slope and the relative index of inequality, which take into account both the population size and the relative socioeconomic position of all groups, rather than only the two most extreme groups. Educational level (< 4 years of school, 4-7 years, and 8 years and over) was used to define socioeconomic position. Multivariable models were fit using Poisson regression and inequality indices were estimated through General Linear Models. All results were adjusted for sex and age. Results from Poisson regression showed improvements in the physical and social environment and some indicators of health services use over time. However, overall social inequalities persisted. Changes in absolute and/or relative indices of inequality were observed for only two outcomes: concern with the condition of/navigating sidewalks and streets and the fear of being robbed. The unequal distribution of relatively fixed resources such as knowledge, wealth, prestige and beneficial social networks among the different educational levels may have contributed to the persistence of inequalities in this older population, confirming theories of education and socioeconomic position as fundamental causes of health inequalities. Modifying these characteristics implies the need for larger reductions in resource inequality, either through social policies that directly influence income or by more equitable social services that minimize individual socioeconomic position as a barrier.
Learning Areas:
Epidemiology
Learning Objectives:
Describe the importance of monitoring the social inequalities trends using summary measures of disparity.
Describe how the choice of different methods for measuring disparity may affects the interpretation of changes in social inequalities.
Compare the slope and the relative index of inequality.
Keyword(s): Aging, Urban Health
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I have been studying health vulnerability and social inequality among elderly population for the last six years, as the subject of my master thesis and my doctoral dissertation. I have also co-authored a paper on the topic.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
