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

Abstract

BackgroundSocioeconomic 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.MethodsIndividual-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.ResultsPrevalence 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.ConclusionsResults 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.

Cholesterol, hypertension and chronic spine problems: a logit model focusing on rural Brazilian residents in 2013

“…Being Caucasian reduces the chance of hypertension by 0.6% over other races, similar to the result from Mainous et al [44]. Relative to those with less than a high school education, individuals with a high school education have an 0.8% smaller chance of contracting the disease and those that moved on to higher education have a 1.1% smaller chance, This result corroborates those from the study by Beltrán-Sánchez and Andrade [32] analyzing the chronic diseases trend in Brazil from 1998…”

“…The rural incidence of the disease cholesterol was higher in women ( Public policies aiming to reduce the incidence of obesity, smoking, and high-fat meat and alcohol consumption while motivating increased physical activity and the consumption of fruits and vegetables would contribute to improve the Brazilian rural population's health and well-being. The results of these policies are likely to be more effective if they focus on individuals in the lower socioeconomic and educational levels [32]. Table 2 shows the results of the marginal effect from the estimated models.…”

Desigualdades regionais e sociais em saúde segundo inquéritos domiciliares (Brasil, 1998-2013)

“…On the other hand, this finding may also be due to a greater knowledge of health status promoted by primary care programs and improved access to health information. This is corroborated by the increase in prevalence of hypertension and diabetes 16,17 , which are priority areas of government health policy and programs such as the Family Health Strategy. In other words, the increase in the diagnosis of chronic diseases as a result of the expansion of primary health programs means that self-assessment of health is likely to be poorer.…”

A panorama of health inequalities in Brazil

“…The article by Malta et al [7] presents predictors of chronic disease prevalence and comorbidity. The article by Alves et al [8] shows the complex interplay of education, gender, and race in measured hypertension, while the article by Beltran-Sanchez et al [9] documents distinct trends in educational inequalities in chronic conditions over the past 15 years.…”