Abstract
ABSTRACTOBJECTIVE To evaluate the magnitude of wealth-related inequalities in basic activities of daily living among community-dwelling Brazilian older adults and to determine the contribution of demographic, socioeconomic, and health conditions to the inequality.METHODS We used data from the 2015 Brazilian Longitudinal Study of Aging (ELSI-Brazil) with a nationally representative sample of adults aged 50 years or older. We assessed wealth-related inequalities in basic activities of daily living by the concentration index. Concentration index was decomposed to determine the contribution of demographic, health, and socioeconomic factors to wealth-related inequalities in basic activities of daily living.RESULTS The prevalence of disability in the sample was 15.7% (95%CI 14.9–17.6). The concentration index was -0.145 (95%CI -0.194– -0.097), which indicates that disability is concentrated in the poorest individuals in Brazil. Inequalities in basic activities of daily living disability are primarily explained by socioeconomic status (wealth and own education) not by demographic or health factors.CONCLUSIONS There are avoidable wealth-related inequities for those with a disability in Brazil. The strong contribution of the socioeconomic status highlights the need for new public health policies that promote equity, universality, and integrality, in addition to the expansion of home nursing public services.
Highlights
Brazil is among the largest countries in the world and the aging process of its population is occurring at a very fast pace[1]
The concentration index was -0.145 (95%CI -0.194– -0.097), which indicates that disability is concentrated in the poorest individuals in Brazil
Inequalities in basic activities of daily living disability are primarily explained by socioeconomic status not by demographic or health factors
Summary
Brazil is among the largest countries in the world and the aging process of its population is occurring at a very fast pace[1]. With a higher proportion of individuals reaching older ages, disability becomes a more prevalent health problem. Education, income, wealth, and social background are evident in Brazil among adults[5,6,7] and older adults[3,4,8,9,10]. These disparities emerge despite the fact that Brazil has a national health system [Sistema Único de Saúde (SUS)] guided by the principle of social equity. Among older adults aged 60–64 years, these inequalities almost doubled during this period[8]
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