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Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017

BACKGROUND: Income inequality can negatively affect population health by increasing social stress and conflict, and reducing trust, public goods and healthcare access. However there is limited evidence from low and middle-income countries (LMICs) with high levels of inequality. This study investigat...

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Autores principales: Gaspar, Renato Simões, Rossi, Ludovico, Hone, Thomas, Dornelles, André Zuanazzi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904117/
https://www.ncbi.nlm.nih.gov/pubmed/36779037
http://dx.doi.org/10.1016/j.lana.2021.100042
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author Gaspar, Renato Simões
Rossi, Ludovico
Hone, Thomas
Dornelles, André Zuanazzi
author_facet Gaspar, Renato Simões
Rossi, Ludovico
Hone, Thomas
Dornelles, André Zuanazzi
author_sort Gaspar, Renato Simões
collection PubMed
description BACKGROUND: Income inequality can negatively affect population health by increasing social stress and conflict, and reducing trust, public goods and healthcare access. However there is limited evidence from low and middle-income countries (LMICs) with high levels of inequality. This study investigates the association between income inequality, morbimortality and risk factors of non-communicable diseases (NCDs) in 26 Brazilian states from 2002 to 2017. METHODS: Data was acquired for men and women from the Global Health Data Exchange, the Brazilian Institute of Geography and Statistics, and the Brazilian Ministry of Health, totalling 416 state-year observations. Disability-adjusted life years (DALYs) and risk factors of NCDs were the dependent variables. Gini Index was the main independent variable. Multivariate linear panel regressions were performed, controlling for state and time fixed effects, gross domestic product per capita, population ageing, poverty and access to healthcare. FINDINGS: A 1% increase in the Gini Index was associated with increases in alcohol abuse (of 923•4 DALYs per 100,000 people, 95%CI 217•6 to 1629•0) and diabetes mellitus morbidity (of 893•3 DALYs per 100,000 people, 95%CI 127•7 to 1659•0), and decreases in morbidity from attention disorder (of -4•0 DALYs per 100,000 people, 95%CI -7•4 to -0•5) and autism spectrum (of -2•4 DALYs per 100,000 people, 95%CI -4•3 to -0•5). These associations were greater for men, further supported by associations with alcohol use as a risk factor. INTERPRETATION: This study provides evidence from a highly unequal LMIC, Brazil, of negative associations between income inequality and NCDs, and the importance of addressing wider social determinants of health. FUNDING: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001 as a Brazilian CAPES scholarship to AZD and by the São Paulo Research Foundation (FAPESP), grant 2020/15944-8 to RSG.
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spelling pubmed-99041172023-02-10 Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017 Gaspar, Renato Simões Rossi, Ludovico Hone, Thomas Dornelles, André Zuanazzi Lancet Reg Health Am Research Paper BACKGROUND: Income inequality can negatively affect population health by increasing social stress and conflict, and reducing trust, public goods and healthcare access. However there is limited evidence from low and middle-income countries (LMICs) with high levels of inequality. This study investigates the association between income inequality, morbimortality and risk factors of non-communicable diseases (NCDs) in 26 Brazilian states from 2002 to 2017. METHODS: Data was acquired for men and women from the Global Health Data Exchange, the Brazilian Institute of Geography and Statistics, and the Brazilian Ministry of Health, totalling 416 state-year observations. Disability-adjusted life years (DALYs) and risk factors of NCDs were the dependent variables. Gini Index was the main independent variable. Multivariate linear panel regressions were performed, controlling for state and time fixed effects, gross domestic product per capita, population ageing, poverty and access to healthcare. FINDINGS: A 1% increase in the Gini Index was associated with increases in alcohol abuse (of 923•4 DALYs per 100,000 people, 95%CI 217•6 to 1629•0) and diabetes mellitus morbidity (of 893•3 DALYs per 100,000 people, 95%CI 127•7 to 1659•0), and decreases in morbidity from attention disorder (of -4•0 DALYs per 100,000 people, 95%CI -7•4 to -0•5) and autism spectrum (of -2•4 DALYs per 100,000 people, 95%CI -4•3 to -0•5). These associations were greater for men, further supported by associations with alcohol use as a risk factor. INTERPRETATION: This study provides evidence from a highly unequal LMIC, Brazil, of negative associations between income inequality and NCDs, and the importance of addressing wider social determinants of health. FUNDING: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001 as a Brazilian CAPES scholarship to AZD and by the São Paulo Research Foundation (FAPESP), grant 2020/15944-8 to RSG. Elsevier 2021-08-17 /pmc/articles/PMC9904117/ /pubmed/36779037 http://dx.doi.org/10.1016/j.lana.2021.100042 Text en © 2021 The Author(s). Published by Elsevier Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Research Paper
Gaspar, Renato Simões
Rossi, Ludovico
Hone, Thomas
Dornelles, André Zuanazzi
Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017
title Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017
title_full Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017
title_fullStr Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017
title_full_unstemmed Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017
title_short Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017
title_sort income inequality and non-communicable disease mortality and morbidity in brazil states: a longitudinal analysis 2002-2017
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904117/
https://www.ncbi.nlm.nih.gov/pubmed/36779037
http://dx.doi.org/10.1016/j.lana.2021.100042
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