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

Hiram Beltrán-Sánchez,Flavia C. D. Andrade

doi:10.1186/s12939-016-0426-5

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.

Highlights

Socioeconomic differences in health in Brazil are largely driven by differences in educational attainment
Results indicate that while the prevalence of diabetes and hypertension have been on the rise, the prevalence of heart disease is declining
This study examined the educational inequalities in the prevalence of diabetes, hypertension and heart disease between 1998 and 2013

Summary

Introduction

Socioeconomic differences in health in Brazil are largely driven by differences in educational attainment. 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. One major effect of these transitions has been an increase in the prevalence of chronic non-communicable diseases, diabetes, hypertension and cardiovascular disease [1]. Estimates for 2013 indicate that Brazil has the fourth largest population of adults aged 20–79 with diabetes in the world (11.9 million; 9.0 % prevalence); this number is expected to rise to 19.2 million (11.7 %) by 2035 [2]. Prevalence of hypertension has been declining in Brazil in the last decades. Prevalence of hypertension remains high in Brazil affecting about one-fourth of all adults [3]

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Results

Discussion

Conclusion