Explaining trends in inequities: evidence from Brazilian child health studies

Victora, César G.; Vaughan, J. G.; Barros, Fernando C.; Silva, Anamaria C; Tomasi, Elaine

doi:10.1016/s0140-6736(00)02741-0

Cited by 591 publications

(473 citation statements)

References 13 publications

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“…Another explanation for the abovementioned association is the so-called Inverse Care Law, which states that good medical care tends to vary inversely with the need of the population served, 33 as richer people often benefit more from public spending on health. 34 Further specifying this explanation, Victora et al 35 raised the inverse equity hypothesis, stating that new public health interventions and programs initially reach individuals in the higher socioeconomic groups. According to their results, the reduction of health inequalities is solely observed in a later stage, when the rich strata already has achieved a new minimum level for morbidity and mortality and the poor gains greater access to the interventions.…”

Section: Discussionmentioning

confidence: 99%

Correlates of influenza vaccine uptake among community-dwelling older adults in Brazil

Andrade

Sato

Moura

et al. 2017

Human Vaccines & Immunotherapeutics

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This study aimed at assessing the factors associated with vaccine uptake in a representative sample of community-dwelling Brazilian older adults, specifically focusing on differences in socioeconomic factors among the country regions. We conducted a cross-sectional, population-based study, using a probabilistic household sample in 2013. Individuals aged 60 years or more answered a structured questionnaire informing on vaccination status and sociodemographic and behavioral covariates. Associations between variables were evaluated using prevalence ratios estimated by Poisson regression models. The overall vaccination coverage (72.6%) in older adults ranked lower than the goal of 80% stipulated by the Brazilian health authority; vaccine uptake differed significantly among the country regions. The prevalence of vaccination was lower in black individuals in Brazil than that in their white counterparts. The prevalence of vaccine uptake was significantly associated with covariates on current life style, use of health care, and socioeconomic determinants. Compared with individuals with 0-3 years of education, more schooled individuals had higher prevalence of vaccine uptake in the North, Northeast, and South regions of the country. This study showed that there is room for increasing vaccination coverage among the elderly in Brazil. The knowledge previously obtained on factors significantly associated with vaccine uptake has not prevented them to continue influencing this outcome. The socioeconomic inequality in vaccination in some Brazilian regions reinforces the need of targeting the intervention toward the most vulnerable groups.

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Section: Discussionmentioning

confidence: 99%

Correlates of influenza vaccine uptake among community-dwelling older adults in Brazil

Andrade

Sato

Moura

et al. 2017

Human Vaccines & Immunotherapeutics

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“…Stunting is a cause of public concern in many developing countries, and reducing stunting prevalence is one of the key components of improving child health. These three indicators have been commonly used in previous literatures for assessing the health status of children (Table A3) [7,9,24,25]. …”

Section: Methodsmentioning

confidence: 99%

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Subramanian

et al. 2017

Global Health Action

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Background: Reducing child mortality was one of the Millennium Development Goals. In the current Sustainable Development Goals era, achieving equity is prioritized as a major aim. Objective: This study aims to provide a comprehensive and updated picture of inequalities in child health intervention coverage and child health outcomes by wealth status, as well as their trends between 2000 and 2014. Methods: Using data from Demographic Health Surveys and Multiple Indicator Cluster Surveys, we adopted three measures of inequality, including one absolute inequality indicator and two relative inequality indicators, to estimate the level and trends of inequalities in three child health outcome variables and 17 intervention coverages in 88 developing countries. Results: While improvements in child health outcomes and coverage of interventions have been observed between 2000 and 2014, large inequalities remain. There was a high level of variation between countries’ progress toward reducing child health inequalities, with some countries significantly improving, some deteriorating, and some remaining statistically unchanged. Among child health interventions, the least equitable one was access to improved sanitation (The absolute difference in coverages between the richest quintile and the poorest quintile reached 49.5% [42.7, 56.2]), followed by access to improved water (34.1% [29.5, 38.6]), and skilled birth attendant (SBA) (34.1% [28.8, 39.4]). The most equitable intervention coverage was insecticide-treated bed net for children (1.0% [−3.9, 5.9]), followed by oral rehydration therapy for diarrhea ((8.0% [5.2, 10.8]), and vitamin A supplement (8.4% [5.1, 11.7]). These findings were robust to various inequality measurements. Conclusions: Although child health outcomes and coverage of interventions have improved largely over the study period for almost all wealth quintiles, insufficient progress was made in reducing child health inequalities between the poorest and richest wealth quintiles. Future efforts should focus on reaching the poorest children by increasing investments toward expanding the coverage of interventions in resource-limited settings.

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“…In Brazil, few studies are available regarding whether perinatal social inequalities are increasing, are remaining stable or are decreasing (12)(13)(14). There is also little information about regional differences in these indicators (15).…”

Section: Introductionmentioning

confidence: 99%

Social inequality and perinatal health: comparison of three Brazilian cohorts

Filho

Junior

Silva

et al. 2007

Braz J Med Biol Res

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The objective of the present study was to estimate and compare social inequality in terms of three indicators, i.e., low birth weight (LBW), preterm birth (PTB) and small for gestational age (SGA) birth, in three birth cohorts. Two cohorts were from the city of Ribeirão Preto, where data were collected for all 6748 live born singletons in 1978/79 and for one third of live born singletons (2846) in 1994. The third cohort consisted of 2443 singletons born in São Luís over a period of one year (1997/98). In Ribeirão Preto, LBW and PTB rates increased in all social strata from 1978/79 to 1994. Social inequalities regarding LBW and PTB disappeared since the increase in these rates was more accelerated in the groups with higher educational level. The percentage of SGA infants increased over the study period. Social inequality regarding SGA birth increased due to a more intense increase in SGA births in the strata with lower schooling. In São Luís, in 1997/98 there was no social inequality in LBW or PTB rates, whereas SGA birth rate was higher in mothers with less schooling. We speculate that the more accelerated increase in medical intervention, especially due to the increase in cesarean sections in the more privileged groups, could be the main factor explaining the unexpected increase in LBW and PTB rates in Ribeirão Preto and the decrease or disappearance of social inequality regarding these perinatal indicators in the two cities. Correspondence

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Explaining trends in inequities: evidence from Brazilian child health studies

Cited by 591 publications

References 13 publications

Correlates of influenza vaccine uptake among community-dwelling older adults in Brazil

Correlates of influenza vaccine uptake among community-dwelling older adults in Brazil

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Social inequality and perinatal health: comparison of three Brazilian cohorts

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