Medindo desigualdades sociais na mortalidade : uma comparação de metodos no municipio de São Paulo

AUTOR(ES)
DATA DE PUBLICAÇÃO

2004

RESUMO

Worldwide economical changes in the eighties and nineties led to greater impoverishment and larger inequalities in income distribution between rich and poor. An increasing interest on equity, social exclusion and social justice was observed. The need to understand and characterize living conditions and health differences between geographical areas and social groups increased the discussion about methods to measure inequalities, in recent publications. An ecological study was designed to study São Paulo City and its districts were considered the smallest ecological unit. The impact of the utilization of several techniques for the construction of homogeneous areas (score 10, score 5, cluster, cluster with standardization, partition and partition with standardization) was analyzed. Several measure of inequality in mortality between socioeconomic strata were also studied: relative risk, attributable risk percent, population attributable risk percent, dissimilarity index, regression curve and index and curve of concentration. The socioeconomic variables were number of school years, income and housing conditions from the 1991 IBGE Census. Population and death data used was from 1999, reported by SEADE (Statistical Data Analysis System of the State of São Paulo). Age standardized global mortality and specific mortality rates, by gender and infant mortality rates, neonatal and postneonatal, and rates by age range and gender were calculated for each socioeconomic strata. Some specific causes of the following groups were studied: external causes, cancer, cardiovascular and infectious diseases. It was observed that partition and cluster with standardization were most sensitive to configure areas of greater internal homogeneity and greater inter area heterogeneity. The use of several measures of distance of the mortality between strata, points out the need to include measure that allow the assessment of intermediate groups. The measurement of the impact of inequalities in the population as a whole is also required, not only in the two extreme groups. The large amount of techniques employed confirmed the negative impact of poor social conditions in greater risk of death of the majority of the groups of causes, several age ranges and on both gender. Causes with greater differences between strata in both gender were: homicide, cerebrovascular, large bowel, rectum, anus and stomach cancer; lung cancer in male and aids in female. Nevertheless, wealthier strata have greater mortality rates in some specific causes These causes are lung, large bowel, rectum and anus cancer and suicide, in both gender. Still, prostate cancer and aids affect male and breast cancer female. Some age range showed greater inequality in the risk of death between strata: male in the 25-34 years (RR=2.62)and 15-24 years (RR=2.50) and female in the 15-24 years (RR=2.27). Inequality dimension varied by cause, gender and age range and also with the cluster technique and measure used. The impact of inequality between gender differed in relation to the specific cause and measure. One of the main conclusions is that the method used to conform the clusters of homogeneous areas and the measure to asses inequality in mortality, sometimes can affect the final results. Thus, the combined use of measures that asses several aspects of social inequality in health, is required. Homicide mortality rates are very important to point out socioeconomic inequalities between strata. Social inequalities in mortality persist in São Paulo. Notwithstanding, simple techniques and measures can be a useful aid for public health services in the identification and surveillance of inequalities

ASSUNTO(S)

saude espaços publicos equidade (direito)

ACESSO AO ARTIGO

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