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      Evolution of inequalities in mortality in Salvador, Bahia State, Brazil, 1991/2006 Translated title: Evolução das desigualdades na mortalidade em Salvador, Bahia, Brasil, 1991/2006


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          An ecological study was carried out with the aim of analyzing the evolution of inequalities in mortality in Salvador, Bahia State, Brazil, between 1991 and 2006. The city was divided into four social strata from 95 geographic Information Zones. The variables used for social stratification were education level and income of heads of households. Crude and age-standardized mortality rates, age specific mortality rates, proportional Infant mortality and the proportional mortality ratio, were calculated for each zone and social strata. Data was obtained from Death Certificates and the Populational Census. Although differences between strata were smaller in 2000 than in 1991, they persist and are still high, ranging from 28.7% to 65.5%. The differences between Information Zones were as much as 575%. The authors discuss the shortcomings of information systems, recommending that health indicators should be estimated by social classes and pointing out the limits and possibilities of the methodology used here.

          Translated abstract

          Com o objetivo de analisar a evolução das desigualdades na mortalidade em Salvador, Bahia, Brasil, entre 1991 e 2006, foi realizado estudo de agregados espacial. A cidade foi dividida em 4 estratos sociais a partir das 95 zonas de informação. As variáveis utilizadas para a estratificação social foram o grau de instrução e a renda dos responsáveis pelos domicílios. Foram calculadas taxa de mortalidade geral, taxa de mortalidade padronizada por idade, mortalidade infantil proporcional e razão de mortalidade proporcional. As fontes de dados foram as Declarações de Óbito dos residentes no município e os Censos Demográficos. Apesar de as diferenças entre os estratos terem sido menores em 2000 em comparação com 1991, elas persistem e ainda são mais elevadas, variando entre 28,7% e 65,5%. Essas diferenças atingiram 57,5% entre as zonas de informação. Os autores discutem as lacunas existentes nos sistemas de informação recomendando que os indicadores de saúde sejam estimados segundo as classes sociais e comentando os limites e possibilidades da metodologia utilizada.

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          Income inequality and population health: a review and explanation of the evidence.

          Whether or not the scale of a society's income inequality is a determinant of population health is still regarded as a controversial issue. We decided to review the evidence and see if we could find a consistent interpretation of both the positive and negative findings. We identified 168 analyses in 155 papers reporting research findings on the association between income distribution and population health, and classified them according to how far their findings supported the hypothesis that greater income differences are associated with lower standards of population health. Analyses in which all adjusted associations between greater income equality and higher standards of population health were statistically significant and positive were classified as "wholly supportive"; if none were significant and positive they were classified as "unsupportive"; and if some but not all were significant and supportive they were classified as "partially supportive". Of those classified as either wholly supportive or unsupportive, a large majority (70 per cent) suggest that health is less good in societies where income differences are bigger. There were substantial differences in the proportion of supportive findings according to whether inequality was measured in large or small areas. We suggest that the studies of income inequality are more supportive in large areas because in that context income inequality serves as a measure of the scale of social stratification, or how hierarchical a society is. We suggest three explanations for the unsupportive findings reported by a minority of studies. First, many studies measured inequality in areas too small to reflect the scale of social class differences in a society; second, a number of studies controlled for factors which, rather than being genuine confounders, are likely either to mediate between class and health or to be other reflections of the scale of social stratification; and third, the international relationship was temporarily lost (in all but the youngest age groups) during the decade from the mid-1980s when income differences were widening particularly rapidly in a number of countries. We finish by discussing possible objections to our interpretation of the findings.
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            Socioeconomic status and health in the Japanese population.

            There is growing interest in the influence of socioeconomic status (SES) on health. Individual SES has been shown to be closely related to mortality, morbidity, health-related behavior and access to health care services in Western countries. Whether the same set of social determinants accounts for higher rates of mortality or morbidity in Japan is questionable, because over the past decade the magnitude of the social stratification within the society has increased due to economic and social circumstances. SES must be interpreted within the economic, social, demographic and cultural contexts of a specific country. In this report we discuss the impact of individuals' socioeconomic position on health in Japan with regard to educational attainment, occupational gradient/class, income level, and unemployment. This review is based mainly on papers indexed in Medline/PubMed between 1990 and 2007. We find that socioeconomic differences in mortality, morbidity and risk factors are not uniformly small in Japan. The majority of papers investigate the relationship between education, occupational class and health, but low income and unemployment are not examined sufficiently in Japan. The results also indicate that different socioeconomic contexts and inequality contribute to the mortality, morbidity, and biological and behavioral risk factors in Japan, although the pattern and direction of the relationships may not necessarily be the same in terms of size, pattern, distribution, magnitude and impact as in Western countries. In particular, the association between higher occupational status and lower mortality, as well as higher educational attainment and either mortality or morbidity, is not as strongly expressed among the Japanese. Japan is still one of the healthiest and most egalitarian nations in the world, and social inequalities within the population are less expressed. However, the magnitude of the social stratification has started to increase, and this is an alarming sign.
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              Income inequality and mortality in metropolitan areas of the United States.

              This study examined associations between income inequality and mortality in 282 US metropolitan areas. Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority.

                Author and article information

                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                : 27
                : suppl 2
                : s176-s184
                [01] Salvador orgnameUniversidade Federal da Bahia orgdiv1Instituto de Saúde Coletiva Brasil
                S0102-311X2011001400006 S0102-311X(11)02700006

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Condições Socias,Inequidade Social,Mortality,Social Conditions,Social Inequity,Mortalidade


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