Brazilian National Household Sample Survey Research Articles

Years of Healthy Life among Older Adults in Brazil: An Analysis Based on the Global Activity Limitation Indicator, 1998 and 2008

The aim of the study was to calculate life expectancy and Healthy Life Expectancy (HLY) through a Global Activity Limitation Indicator (GALI) proxy among Brazilian older adults according to sex for the years 1998 and 2008. The study was carried out using data from the Brazilian National Household Sample Survey (PNAD) and from Abbreviated Life Tables in 2000 and 2010 from Brazilian Institute of Demographic Geography and Statistics (IBGE) by sex. The activity limitation-free life expectancy was estimate based on the GALI for both sexes using the Sullivan method. The results showed an increase in life expectancy in the period for both sexes. The time of life without activity limitations in 2008 has decreased for men. For women, a reduction in percentage of the time lived without activity limitation has been shown. A small advantage in favor of men compare to women’s health was found. Comparing the two periods, the proportion of years expected to be lived without activity limitation was higher in 1998 than in 2008 and for both sexes. There are still many uncertainties about how the country is actually ageing. Given this context, an effort to maintain constant health monitoring through different indicators such as GALI is essential. At the same time, strengthening local and regional policies, aiming to build solid paths and mechanisms to promote an active and healthy ageing of its population must be a target.

Food insecurity in Brazil by household arrangements and characteristics between 2004 and 2022.

Although food insecurity presents a decreasing trend worldwide, some regions recently observed an increase in hunger levels. Such was the case in Brazil between 2014 and 2018, during and after the great Brazilian recession, and between 2020 and 2021, during the COVID-19 pandemic. This paper describes the evolution of food insecurity in Brazil between 2004 and 2022 using Brazilian National Household Sample Survey (PNAD), Brazilian Household Budget Survey (POF) and Continuous PNAD. Households were classified in 20 types of arrangements, and the most vulnerable living arrangements between 2004 and 2018 were identified by multinomial logistic models. Overall, households headed by women (single blacks, whites or in couples) with or without children were the most prone to food insecurity. As for the evolution of food insecurity in Brazil between 2018 and 2022, logistic models were applied to estimate moderate and severe food insecurity levels among the 20 household types. Additionally, effects of the emergency aid and idiosyncrasies of the COVID-19 pandemic were estimated.

Prediction of Multimorbidity in Brazil: Latest Fifth of a Century Population Study.

Multimorbidity is characterized by the co-occurrence of 2 or more chronic diseases and has been a focus of the health care sector and health policy makers due to its severe adverse effects. This paper aims to use the latest 2 decades of national health data in Brazil to analyze the effects of demographic factors and predict the impact of various risk factors on multimorbidity. Data analysis methods include descriptive analysis, logistic regression, and nomogram prediction. The study makes use of a set of national cross-sectional data with a sample size of 877,032. The study used data from 1998, 2003, and 2008 from the Brazilian National Household Sample Survey, and from 2013 and 2019 from the Brazilian National Health Survey. We developed a logistic regression model to assess the influence of risk factors on multimorbidity and predict the influence of the key risk factors in the future, based on the prevalence of multimorbidity in Brazil. Overall, females were 1.7 times more likely to experience multimorbidity than males (odds ratio [OR] 1.72, 95% CI 1.69-1.74). The prevalence of multimorbidity among unemployed individuals was 1.5 times that of employed individuals (OR 1.51, 95% CI 1.49-1.53). Multimorbidity prevalence increased significantly with age. People over 60 years of age were about 20 times more likely to have multiple chronic diseases than those between 18 and 29 years of age (OR 19.6, 95% CI 19.15-20.07). The prevalence of multimorbidity in illiterate individuals was 1.2 times that in literate ones (OR 1.26, 95% CI 1.24-1.28). The subjective well-being of seniors without multimorbidity was 15 times that among people with multimorbidity (OR 15.29, 95% CI 14.97-15.63). Adults with multimorbidity were more than 1.5 times more likely to be hospitalized than those without (OR 1.53, 95% CI 1.50-1.56) and 1.9 times more likely need medical care (OR 1.94, 95% CI 1.91-1.97). These patterns were similar in all 5 cohort studies and remained stable for over 21 years. A nomogram model was used to predict multimorbidity prevalence under the influence of various risk factors. The prediction results were consistent with the effects of logistic regression; older age and poorer participant well-being had the strongest correlation with multimorbidity. Our study shows that multimorbidity prevalence varied little in the past 2 decades but varies widely across social groups. Identifying populations with higher rates of multimorbidity prevalence may improve policy making around multimorbidity prevention and management. The Brazilian government can create public health policies targeting these groups, and provide more medical treatment and health services to support and protect the multimorbidity population.

Prevalence of flu-like syndrome in healthcare workers in Brazil: a national study, 2020.

To evaluate the prevalence of reported symptoms of flu-like syndrome (FS) among HCW and compare HCW and non-HCW on the chance of reporting these symptoms, this study analyzed data of a population-based survey conducted in Brazil. A cross-sectional analysis was performed with self-reported data from the Brazilian National Household Sample Survey (PNAD Covid-19) from May 2020. The authors analyzed a probability sample of 125,179 workers, aged 18 to 65, with monthly income lower than US$ 3 500. The variable HCW or non-HCW was the covariate of interest and having reported FS symptoms or not was the outcome variable. Authors tested interactions of HCW with other covariates. A logit model - when controlling for sociodemographic, employment, and geographic characteristics - investigated the chance of HCW reporting FS compared to non-HCW. HCW have a significant effect (odds ratio of 1.369) on reporting FS symptoms when compared to non-HCW. HCW account for 4.17% of the sample, with a higher frequency of FS (3.38%) than observed for non-HCW (2.43%). Female, non-white and older individuals had higher chance to report FS. The HCW had a higher chance of reporting symptoms than non-HCW aged over 18 years in the labor force. These results emphasize guidelines for preventive measures to reduce workplace exposures in the healthcare facilities. The prevalence is disproportionately affecting HCW women and HCW non-whites. In the regions North and Northeast the steeper progression is consistent with the hypothesis of socioeconomic factors, and it explains the greater prevalence in HCW and non-HCW living in those territories.

Time use and food insecurity in female-headed households in Brazil

In Brazil, female-headed households disproportionately experience food insecurity. However, empirical and theoretical evidence shows that women are better than men at allocating intra-household resources to achieve well-being. In observation of this paradox, the present work studies the process of poverty feminization, and presents a collective decision model to understand the vulnerability situation of women. Specifically, we aimed to observe how time use and food insecurity correlate. We estimated an ordered probit model with Brazilian National Household Sample Survey data. Our studies found that women manage a double burden of both paid and unpaid jobs. This increases their risk of food insecurity, confirming the importance of time allocation in household well-being. Conversely, this effect is inverted when household tasks are shared with another member, specifically the spouse. Single mother households still face several challenges, which require specific policies and studies.

Coresidence increases the risk of testing positive for COVID-19 among older Brazilians

BackgroundBrazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact and thus potential infection.MethodsUsing nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios), collected between July and November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians aged 60 years and older. We examine whether living arrangements influence self-reported COVID-19 symptoms as an indicator of subjective health assessment, testing as an indicator of health care service use, and a positive COVID-19 test result as an objective indicator of exposure to the disease.ResultsLiving arrangements shape older adults’ vulnerabilities to COVID-19 exposure and testing. Specifically, those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households.ConclusionsOverall, our findings suggest that coresidence with younger family members puts older adults’ health at risk in the context of COVID-19. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.

Regional and social inequalities in food insecurity in Brazil, 2013-2018.

This study aims to analyze the association between social indicators and the worsening of food insecurity in 2013 and 2018 in different regions of Brazil. Data from the Brazilian National Household Sample Survey (2013) and Brazilian Household Budgets Survey (2018) were analyzed, considering nationally representative samples of 110,750 and 57,920 households, respectively. Food insecurity was assessed using the Brazilian Food Insecurity Scale by estimating the percentage changes in food insecurity levels between 2013 and 2018, according to sociodemographic variables. The association between social indicators and food insecurity disaggregated by region was estimated using multinomial logistic regression models. Although North and Northeast regions had higher proportions of food insecurity, the Southeast and Central-West regions had the highest increase in food insecurity in the same periods. Income was the indicator with the highest association with food insecurity both in 2013 and 2018. We also observed the association between the presence of three or more residents aged under 18 in a household and a higher risk of food insecurity in North and South regions. Food insecurity increased unevenly among regions during the Brazilian economic crisis, which reinforced regional inequality. Moreover, food insecurity was greater among households with worse social and economic living conditions, contributing to social inequality in the country. Thus, strengthening public policies to promote food security and nutrition according to regional social inequities is necessary.

Coresidence Increases Risk of Testing Positive for COVID-19 Among Older Brazilians

Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact. Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey, collected from July to November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians 60+. Our multivariate analyses utilize multilevel mixed-effects Poisson regression to examine the association between living arrangements and the COVID-19 outcome measures. Results show that those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational (PR=1.532, 95% CI 1.15, 2.04, p<0.001) and skipped generation households (PR=1.607, 95% CI 1.04, 2.48, p<0.001) were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households. Overall, our findings suggest that coresidence with younger family members is a risk factor for older adults’ health due to the higher COVID-19 positivity. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.

Do conditional cash transfers increase schooling among adolescents?

In several Latin American countries, conditional cash transfer programmes are a proven means of alleviating poverty in the short term and promoting education of children from disadvantaged families in the longer run. While the effectiveness of the Brazilian Bolsa Família for children’s education outcomes up to 15 years of age has been widely documented, its contribution to the promotion of students of secondary school age has not been fully explored in light of the programme’s expansion to 16-17 years olds in 2008. In this paper, I draw on Brazilian National Household Sample Survey data and use a difference-in-differences approach already applied in research in the context of Bolsa Família extension. Whereas these data were previously examined to detect intent-to-treat (ITT) effects due to insufficient information on treatment status, in this study I rely on a classifier method to additionally estimate average treatment effects on the treated who belong to families supposedly receiving Bolsa Família cash transfers. The results suggest that school attendance rates for 16-year-olds are particularly increased in the Brazilian Northeast, although the estimates are not significant when further time periods are taken into account. As comparably poor but non-recipient households have larger and consistently significant gains of school attendance, the effect on adolescent’s education directly caused by the expansion of Bolsa Família remains ambiguous and thus cast doubt on the specific parallel trend assumption. In addition, no long-run ITT effects of the programme’s expansion on school participation among 16 year old teenagers are found.

Estimated prevalence of COVID-19 in Brazil with probabilistic bias correction.

Using data collected by the Brazilian National Household Sample Survey - COVID-19 (PNAD-COVID19) and semi-Bayesian modelling developed by Wu et al., we have estimated the effect of underreporting of COVID-19 cases in Brazil as of December 2020. The total number of infected individuals is about 3 to 8 times the number of cases reported, depending on the state. Confirmed cases are at 3.1% of the total population and our estimate of total cases is at almost 15% of the approximately 212 million Brazilians as of 2020. The method we adopted from Wu et al., with slight modifications in prior specifications, applies bias corrections to account for incomplete testing and imperfect test accuracy. Our estimates, which are comparable to results obtained by Wu et al. for the United States, indicate that projections from compartmental models (such as SEIR models) tend to overestimate the number of infections and that there is considerable regional heterogeneity (results are presented by state).

Latent class analysis of COVID-19 symptoms in Brazil: results of the PNAD-COVID19 survey.

The lack of mass testing for COVID-19 diagnosis creates the need to determine the magnitude of the disease based on its clinical symptoms. The study aimed to analyze the profile of COVID-19 symptoms and related aspects in Brazil. The author analyzed the sample of participants from the Brazilian National Household Sample Survey (PNAD-COVID19) conducted in May 2020. Latent class analysis (LCA) was performed with sociodemographic covariables and 11 symptoms reported by 346,181 individuals. Rao-Scott test and standardized residual analysis were used to measure the association with the pattern of health services use. Spatial scan analysis was performed to identify areas at risk of COVID-19 cases. LCA showed six classes of symptoms based on the pattern of answers by participants: (1) all the symptoms; (2) high prevalence of symptoms; (3) predominance of fever; (4) predominance of cough/sore throat; (5) mild symptoms with predominance of headache; and (6) absence of symptoms. Female sex, brown skin color, the North and Northeast regions of Brazil, and all three older age brackets showed stronger association with the class with all the symptoms (class 1). Most use of health services was also by this group of individuals, but with different profiles of use. Spatial analysis showed juxtaposition of this class with areas at greater risk of COVID-19. These finding underline the importance of investigating symptoms for the epidemiological identification of possible cases in a scenario with low population testing rates.

"Measuring hunger": psychometric scales of food insecurity and indigenous peoples in Brazil

The Brazilian Food Insecurity Scale (EBIA) was validated for the Brazilian context in 2004. Since then, the scale has evaluated and measured the experience of food insecurity in rural and urban households, initially in the Brazilian National Household Sample Survey and later in the Brazilian National Survey of Demographic and Health. However, indigenous peoples have not been examined specifically in these surveys, despite recognition of their food and nutritional vulnerability. In this scenario, we analyze and discuss the application of the EBIA among indigenous peoples in Brazil, based on a set of fundamental questions for understanding and measuring their experience with food insecurity and "hunger". We conduct a sociopolitical and ethnographic analysis of a set of official documents and significant articles on the use of psychometric scales of food insecurity among Brazilian indigenous peoples, compared to international studies on the validation and application of scales in other sociocultural contexts. The initiatives with adaptation and application of the EBIA to indigenous peoples in Brazil indicate that understanding and measuring food insecurity in these peoples poses a major challenge. Particularly complex is the proposal to guarantee comparability of different contexts while taking into account the multiple local singularities. We propose that ethnographic studies should serve as specific components of future initiatives on this topic and that they should cover aspects such as the seasonality of indigenous peoples' food production, different processes of food monetization, and the dynamics of their food systems.

Race, Class and Income Inequality in Brazil: A Social Trajectory Analysis

ABSTRACT The article deals with the relationship between race, class and income in Brazil, with the main objective of investigating the determinants of racial inequality in the country’s labour market. By making use of structural equation models, it analyses the process of setting income differentials between whites and blacks, from their social origin to the definition of wages, through schooling and occupational allocation. The analysis, based on data from the Brazilian National Household Sample Survey, collected in 2014, allows us to compare direct, indirect and total effects of race and social origin on income from work. Results show that, although the total effects of social origin are larger than racial effects, the former cannot explain most disadvantages suffered by blacks nowadays in Brazil, which occur mainly indirectly – through education and occupation. Thus, the study brings new, updated and more detailed evidence to a long-standing debate.

The economic and social determinants of participation in physical activity in Brazil

ABSTRACTThis paper examines the economic and social factors that influence the frequency of participation in physical activity in Brazil. Employing a modified allocation of time framework, we use data sourced from the 2015 Brazilian National Household Sample Survey to analyse the frequency of participation in physical activity for men and women between the age of 18 and 64. Using a conventional ordered logistic regression model, our results suggest that several economic and social factors influence the frequency of physical activity participation in Brazil. For instance, we find that household income has a very small but positive effect on the frequency of participation in physical activity while, in contrast, full-time employment and caring for dependent children have a larger negative for both men and women. Thus, social policies designed to make physical activity more convenient in the workforce may help to facilitate more frequent participation in physical activity.

The wage penalty of smoking in Brazil: evidence from the Special Survey on Tobacco Addiction

The aim of this study is to investigate the hypothesis that smoking reduces earnings. We use data from the Special Survey on Tobacco Addiction, which was jointly carried out with the 2008 Brazilian National Household Sample Survey. Our results support the hypothesis that smoking reduces wages. Furthermore, we found that about two-thirds of wage differential between male smokers and non-smokers is due to observable characteristics.

Isolated illiteracy and access to social programs: evidence from Brazil

PurposeThe purpose of this paper is to investigate whether isolated illiteracy generates a barrier to knowledge about the Brazilian Federal Government’s Single Registry for social programs.Design/methodology/approachBased on information contained in the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicilios – PNAD) 2014, the propensity score matching method was combined with the algorithm proposed by Imbens (2015). The analyzed sample consists of two groups of illiterate individuals: isolated illiterates (IILs) (treatment group), which consists of only illiterate individuals who live with other illiterates; and proximate illiterates (PILs) (control group), which consists of illiterates who live with someone who is literate in the household.FindingsEvidence indicates that IIL individuals are, on average, less likely to know about the single registry than PIL people.Research limitations/implicationsThe main limitation relates to the database since the only information available in the PNAD on the access to the single registry is for the year 2014.Practical implicationsThe evidence found in the study reinforces the need to invest in the fight against illiteracy in Brazil.Social implicationsResults show that a portion of the possible beneficiaries of social programs are still “invisible” to the government’s social protection networks, and this highlights the existence of possible errors of exclusion.Originality/valueThe paper compares two groups of illiterate people, a group that lives in an isolated illiteracy situation and the other that does not. It also assesses the effect of literacy externalities on the access to the Brazilian Single Registry.

Multiple inequity in health care: An example from Brazil

The paper develops and illustrates a new multivariate approach to analysing inequity in health care. We measure multiple inequity in health care relating to multiple equity-relevant variables – including income, gender, ethnicity, rurality, insurance status and others – and decompose the contribution of each variable to multiple inequity. Our approach encompasses the standard bivariate approach as a special case in which there is only one equity-relevant variable, such as income. We illustrate through an application to physician visits in Brazil, using data from the Health and Health Care Supplement of the Brazilian National Household Sample Survey, comprising 391,868 individuals in the year 2008. We find that health insurance coverage and urban location both contribute more to multiple inequity than income. We hope this approach will help researchers and analysts shed light on the comparative size and importance of the many different inequities in health care of interest to decision makers, rather than focus narrowly on income-related inequity.

Food security status in times of financial and political crisis in Brazil.

This study sought to describe the changes in the food security status in Brazil before and during its most recent financial and political crisis, as well as to explore associations between food security and socioeconomic factors during the crisis. This cross-sectional study analyzed data from two different sources: the Brazilian National Household Sample Survey for 2004 (n = 112,479), 2009 (n = 120,910), and 2013 (n = 116,192); and the Gallup World Poll for 2015 (n = 1,004), 2016 (n = 1,002), and 2017 (n = 1,001). Household food security status was measured by a shorter version of the Brazilian Food Insecurity Scale, consisting of the first 8 questions of the original 14-item scale. Descriptive and logistic regression analyses were performed to assess the changes in food security and their association with socioeconomic factors. Results suggest that during the crisis the percentage of households classified as food secure declined by one third (76% in 2013 to 49% in 2017) while severe food insecurity tripled (4% in 2013 to 12% in 2017). Whereas before the crisis (2013) 44% of the poorest households were food secure, by 2017 this decreased to 26%. Household income per capita was strongly associated with food security, increasing by six times the chances of being food insecure among the poorest strata. Those who reported a low job climate, social support or level of education were twice as likely to be food insecure. Despite significant improvements between 2004 and 2013, findings indicate that during the crisis Brazil suffered from a great deterioration of food security, highlighting the need for emergency policies to protect and guarantee access to food for the most vulnerable.

Suitability of the eight-item version of the Brazilian Household Food Insecurity Measurement Scale to identify risk groups: evidence from a nationwide representative sample.

The Brazilian Household Food Insecurity Measurement Scale (EBIA) has eight general/adult items applied in all households and six additional items exclusively asked in households with children and/or adolescents (HHCA). Continuing an investigation programme on the adequacy of model-based cut-off points for EBIA, the present study aims to: (i) explore the capacity of properly stratifying HHCA according to food insecurity (FI) severity level by applying only the eight 'generic' items; and (ii) compare it against the fourteen-item scale. Latent class factor analysis (LCFA) models were applied to the answers to the eight general/adult items to identify latent groups corresponding to FI levels and optimal group-separating cut-off points. Analyses involved a thorough classification agreement evaluation and were performed at the national level and by macro-regions. Data derived from the cross-sectional Brazilian National Household Sample Survey of 2013. A nationally representative sample of 116 543 households. In all households and investigated domains, LCFA detected four distinct household food (in)security groups (food security and three levels of severity of FI) and the same set of cut-off points (1/2, 4/5 and 6/7). Misclassification in the aggregate data was 0·66 % in adult-only households and 1·06 % in HHCA. Comparison of the scale reduced to eight items with the 'original' fourteen-item scale demonstrated consistency in the classification. In HHCA, the agreement between both classifications was 96·2 %. Results indicate the eight 'generic' items in HHCA can be reliably used when it is not possible to apply the fourteen-item scale.

Urban-rural gradient in tobacco consumption and cessation patterns in Brazil

The degree of urbanization has been associated with both tobacco consumption and quit rates. The current study aims to examine the importance of the urban-rural context in the determination of tobacco consumption patterns and smoking cessation. Data were used from the supplement of the Special Survey on Smoking (PETab) from the 2008 Brazilian National Household Sample Survey (PNAD). The sample included 14,420 individuals over 15 years of age, of whom 7,003 were current smokers and 7,417 former smokers in the PETab. Smoking prevalence and cessation rates were calculated. Individuals were stratified according to urban and rural residence. Other sociodemographic variables were also analyzed: sex, age bracket, race, and schooling. To explore the difference in smoking prevalence and cessation rate for each stratum in the census situation, the data were adjusted using a Poisson model. Smoking prevalence was higher in places less influenced by the urban environment. Meanwhile, smoking cessation was higher in more urbanized places. Smoking prevalence showed a decrease in consumption as the population's urban characteristics increased (PR = 0.75 for eminently urban vs eminently rural, p = 0.001). Smoking cessation trends showed that the more urban population was more prone to quitting (PR = 1.22 for eminently urban vs eminently rural, p < 0.001). The results point to the need to improve the effectiveness of services for follow-up and encouragement of cessation in rural areas.