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Time trends in adult chronic disease inequalities by education in Brazil: 1998–2013

BACKGROUND: Socioeconomic differences in health in Brazil are largely driven by differences in educational attainment. In this paper, we assess whether educational gradients in chronic disease prevalence have narrowed in Brazil from 1998 to 2013, a period of a booming economy accompanied by major in...

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Autores principales: Beltrán-Sánchez, Hiram, Andrade, Flavia C. D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112754/
https://www.ncbi.nlm.nih.gov/pubmed/27852329
http://dx.doi.org/10.1186/s12939-016-0426-5
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author Beltrán-Sánchez, Hiram
Andrade, Flavia C. D.
author_facet Beltrán-Sánchez, Hiram
Andrade, Flavia C. D.
author_sort Beltrán-Sánchez, Hiram
collection PubMed
description BACKGROUND: Socioeconomic differences in health in Brazil are largely driven by differences in educational attainment. In this paper, we assess whether educational gradients in chronic disease prevalence have narrowed in Brazil from 1998 to 2013, a period of a booming economy accompanied by major investments in public health in the country. METHODS: Individual-level data came from the 1998, 2003 and 2008 Brazilian National Household Survey and the 2013 National Health Survey. We first evaluate age-standardized prevalence rates of chronic disease by education and second, we predict the estimated prevalence rate between those in low vs. high education to assess if relative changes in chronic disease have narrowed over time. Third, we estimate the slope index of inequality (SII) that evaluates the absolute change in the predicted prevalence of a disease between those in low vs. high education. Finally, we tested for statistically significant time trends in adult chronic disease inequalities by education. RESULTS: Prevalence of diabetes and hypertension have increased over the period, whereas the prevalence of heart disease decreased. Brazilian adults with no education had higher levels of diabetes, hypertension and heart disease than those with some college or more. Adjusted prevalence for hypertension and heart disease indicate some progress in reducing educational disparities over time. However, for diabetes, adjusted results show a continuously increasing educational disparity from 1998 to 2013. By 2013, individuals with no education had about two times higher diabetes prevalence than those with higher education with larger disparity among women. CONCLUSIONS: Results confirm findings from previous work that educational inequalities in health are large in Brazil but also provide evidence suggesting some improvement in narrowing these differentials in recent times. Recent policies aiming at reducing the prevalence of obesity, smoking and alcohol consumption, and increasing physical activity and consumption of fruits and vegetables may increase the overall health and wellbeing of the Brazilian population. These programs are likely to be more effective if they target those with low socioeconomic status, as they appeared to be at a higher risk of developing chronic conditions, and promote educational opportunities.
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spelling pubmed-51127542016-11-23 Time trends in adult chronic disease inequalities by education in Brazil: 1998–2013 Beltrán-Sánchez, Hiram Andrade, Flavia C. D. Int J Equity Health Research BACKGROUND: Socioeconomic differences in health in Brazil are largely driven by differences in educational attainment. In this paper, we assess whether educational gradients in chronic disease prevalence have narrowed in Brazil from 1998 to 2013, a period of a booming economy accompanied by major investments in public health in the country. METHODS: Individual-level data came from the 1998, 2003 and 2008 Brazilian National Household Survey and the 2013 National Health Survey. We first evaluate age-standardized prevalence rates of chronic disease by education and second, we predict the estimated prevalence rate between those in low vs. high education to assess if relative changes in chronic disease have narrowed over time. Third, we estimate the slope index of inequality (SII) that evaluates the absolute change in the predicted prevalence of a disease between those in low vs. high education. Finally, we tested for statistically significant time trends in adult chronic disease inequalities by education. RESULTS: Prevalence of diabetes and hypertension have increased over the period, whereas the prevalence of heart disease decreased. Brazilian adults with no education had higher levels of diabetes, hypertension and heart disease than those with some college or more. Adjusted prevalence for hypertension and heart disease indicate some progress in reducing educational disparities over time. However, for diabetes, adjusted results show a continuously increasing educational disparity from 1998 to 2013. By 2013, individuals with no education had about two times higher diabetes prevalence than those with higher education with larger disparity among women. CONCLUSIONS: Results confirm findings from previous work that educational inequalities in health are large in Brazil but also provide evidence suggesting some improvement in narrowing these differentials in recent times. Recent policies aiming at reducing the prevalence of obesity, smoking and alcohol consumption, and increasing physical activity and consumption of fruits and vegetables may increase the overall health and wellbeing of the Brazilian population. These programs are likely to be more effective if they target those with low socioeconomic status, as they appeared to be at a higher risk of developing chronic conditions, and promote educational opportunities. BioMed Central 2016-11-17 /pmc/articles/PMC5112754/ /pubmed/27852329 http://dx.doi.org/10.1186/s12939-016-0426-5 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Beltrán-Sánchez, Hiram
Andrade, Flavia C. D.
Time trends in adult chronic disease inequalities by education in Brazil: 1998–2013
title Time trends in adult chronic disease inequalities by education in Brazil: 1998–2013
title_full Time trends in adult chronic disease inequalities by education in Brazil: 1998–2013
title_fullStr Time trends in adult chronic disease inequalities by education in Brazil: 1998–2013
title_full_unstemmed Time trends in adult chronic disease inequalities by education in Brazil: 1998–2013
title_short Time trends in adult chronic disease inequalities by education in Brazil: 1998–2013
title_sort time trends in adult chronic disease inequalities by education in brazil: 1998–2013
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112754/
https://www.ncbi.nlm.nih.gov/pubmed/27852329
http://dx.doi.org/10.1186/s12939-016-0426-5
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