یک تحلیل چند سطحی در مورد نابرابری جغرافیایی کم در امید به زندگی
Abstract
Introduction
Methods
Results
Discussion
References
Abstract
Objectives To analyze the geographic inequalities in life expectancy (LE) and the probability of survival up to 40 and 60 years in Brazil between 1991 and 2010, to partition the variance of these indicators by including municipalities, states, and macroregions in the analysis, and to test the association between municipal socio-economic and health services indicators with life expectancy.
Study design Multilevel analysis.
Methods Census data from 1991, 2000, and 2010 were used to calculate the outcomes and the socio-economic variables. Municipalities were separated into centiles according to their values in each outcome. Absolute and relative differences were calculated for each year. Multilevel linear regression models were performed, taking into account three levels: regions, states, and municipalities. Municipal socio-economic and health services variables were included in the model with the 2010 data.
Results All 5545 Brazilian counties showed improvement in the three indicators, but the magnitude varied significantly across the country. The highest gains in LE were observed in the North and Northeast regions. The gap in LE between the 1st and 99th percentile decreased from 19.6 years to 12.2 years. The relative difference also fell, from 1.37 to 1.18. Most counties’ socio-economic and health services indicators were associated with the outcomes and explained 86.7%, 31.2%, and 32.4% of the variation in LE attributable to regions, states, and counties, respectively.
Conclusions The average life expectancy increased between 1991 and 2010. Concomitantly, a reduction in geographic disparities was observed. The counties’ socio-economic and health services variables explained much of the variation of the outcomes in 2010.
Introduction
Globally, life expectancy (LE) has increased substantially throughout the twentieth century and the first decades of the twenty-first century. Between 1950 and 2017, the LE went from 48.1 to 70.5 years among men and from 52.9 to 75.6 years among women.1 Brazil follows the same pattern in LE, increasing from 36.5 to 75.4 years between 1930 and 2015.2,3 This indicator reflects changes in the living conditions of the population, including increases in income, improvements in educational level and sanitary conditions, and advances in medicine.1 However, at the same time that LE is increasing, and humanity is expanding its knowledge of how to live longer, the literature has shown an increase in the geographic and socio-economic inequality of LE within many countries. In Belgium, the educational difference in LE (and LE without disabilities) increased between the 1990s and 2000s.4 The widening of social inequality in LE and/or quality-adjusted life expectancy (QALE) was also observed in Denmark (1980se2010s),5 United States (1980se2010s),6 England (1980se2010s),7 Netherlands (2000se2010s),8 Estonia (1980se2000s),9 New Zealand (1980se2000s)10 and Russia (1980se2000s),11 whether between regions or populational groups. Brazil has been one of the most unequal countries in the world for decades.