P3 Area deprivation measures in brazil: a scoping review

Abstract

Background Brazil is a country with high rates of inequality. Although overall poverty rates have declined and global measures of socioeconomic conditions have shown consistent improvements in recent decades, internal disparities remain substantial. Area-based deprivation indices are important for understanding social inequalities. The purpose of this review is to inform the development of a small area deprivation index for Brazil, describing and assessing currently used area based measures of socioeconomic inequalities in Brazil for health research. Methods We searched five electronic databases and seven websites of Brazilian research institutions and governmental agencies. Inclusion criteria were multiple measures of deprivation, small areas (i.e. finer geography than country-level) in Brazil. Studies had to be published in English, Portuguese or Spanish. We extracted data on study characteristics, name of the deprivation measure, area level, geographical coverage, variables used to calculate the index and whether it was used to report a health outcome. Results were tabulated according to the area-level used and dimensions of deprivation or poverty included in the measures. We used a narrative synthesis approach to summarise the different deprivation measures available, highlighting their strengths and weaknesses for application to public health research. Results A total of 7199 records were retrieved, 126 full text articles were assessed using the inclusion criteria and a final list of 30 articles were selected. Most of the studies were excluded as they did not focus on area level measurements (n=69). We identified no small area deprivation measures that have been applied to the whole of Brazil. Three studies did cover the entire country of Brazil but the ‘small areas’ used were municipalities with an average population of 37 000. We found limited deprivation measures using the census tract area level and few measures using the most recent 2010 Census. Papers were grouped into six dimensions: income, education, sanitation, household conditions, ethnicity and others. These measures were mainly used to study infectious and parasitic diseases. Few studies used the measures to assess inequalities in mortality and no studies used the deprivation measure to evaluate the impact of social programs. Conclusion Currently there is no up-to-date small area-based deprivation measure that covers the whole of Brazil. Area-based deprivation indicators have been in use in the UK and other countries for over 30 years. There is a need to develop a similar small-area deprivation index for Brazil that can be used to measure and monitor inequalities in health and mortality.