Duarte Elisabeth Carmen, Schneider Maria Cristina, Paes-Sousa Rômulo, da Silva Jarbas Barbosa, Castillo-Salgado Carlos
Ministério da Saúde, Fundação Nacional de Saúde, Centro Nacional de Epidemiologia, Brasília, Brasil.
Rev Panam Salud Publica. 2002 Dec;12(6):436-44. doi: 10.1590/s1020-49892002001200009.
To analyze the inequalities found using health indicators in the states and regions of Brazil, according to 1999 socioeconomic and demographic indicators.
An exploratory ecological cross-sectional study was carried out. The units of analysis were Brazilian states (n = 27) and regions (n = 5). Descriptive measures of inequality were calculated. Pearson's correlation and also linear regression analysis were used to identify associations between health indicators and selected socio-economic and demographic indicators. The health indicators analyzed were: life expectancy at birth, infant mortality rate, mortality rate for children < 5 years due to acute diarrheal diseases and to acute respiratory infections, and deaths due to homicides and traffic accidents.
Important gains were seen in life expectancy at birth over the 1991-1999 period, especially for males. There was a trend towards larger gains in states that had had lower life expectancy at birth in 1991, which produced greater homogeneity across Brazil in this indicator in recent years. The infant mortality rate decreased by 28% between 1991 and 1999. However, this indicator still varies widely among the regions--from 52.5 per 1,000 live births in the northeast to 17.1 per 1,000 in the south--and among states--from 64.0 per 1,000 in Alagoas to 15.1 per 1,000 in Rio Grande do Sul. With respect to children < 5 years, the mortality rate due to acute diarrheal diseases was equal to or higher than the national median (4.1 per 10,000) in all the north-eastern states, and the mortality rate due to acute respiratory infections was equal to or higher than the national median (10.8 per 10,000) in all the southern, southeastern, and central-western states. The mortality rates (standardized by sex and age) due to traffic accidents and to homicides in 1999 were 17.7 and 26.0 per 100,000 inhabitants, respectively. Extreme values were found in some states for mortality due to homicide (57.8 per 100,000 in Pernambuco) and traffic accidents (54.5 per 100,000 in Roraima). The mortality rate due to homicide was strongly associated with urbanization (P = 0.001). Higher mortality rates due to traffic accidents were associated with lower poverty levels (beta = -0.93; P < 0.001), lower literacy rates (beta = -1.16; P = 0.005), and larger population growth over the past decade (beta = 3.10; P = 0.016).
The pattern of health inequality in Brazil indicates a polarization among regions and states as well as a juxtaposition of diseases associated with under-development and diseases linked to development, suggesting the need for a health system that is committed to addressing these issues.
根据1999年社会经济和人口指标，分析巴西各州和地区在使用健康指标时发现的不平等情况。
开展了一项探索性生态横断面研究。分析单位为巴西各州（n = 27）和地区（n = 5）。计算了不平等的描述性指标。使用Pearson相关性分析和线性回归分析来确定健康指标与选定的社会经济和人口指标之间的关联。分析的健康指标包括：出生时预期寿命、婴儿死亡率、5岁以下儿童因急性腹泻病和急性呼吸道感染导致的死亡率，以及因凶杀和交通事故导致的死亡人数。
在1991 - 1999年期间，出生时预期寿命有显著提高，尤其是男性。1991年出生时预期寿命较低的州有更大的增长趋势，这使得近年来巴西在该指标上的地区差异减小。1991年至1999年期间，婴儿死亡率下降了28%。然而，该指标在各地区之间仍有很大差异——从东北部每1000例活产中的52.5例到南部的每1000例中的17.1例——在各州之间也存在差异——从阿拉戈斯州的每1000例中的64.0例到南里奥格兰德州的每1000例中的15.1例。对于5岁以下儿童，所有东北部州因急性腹泻病导致的死亡率等于或高于全国中位数（每10000例中的4.1例），所有南部、东南部和中西部州因急性呼吸道感染导致的死亡率等于或高于全国中位数（每10000例中的10.8例）。1999年因交通事故和凶杀导致的死亡率（按性别和年龄标准化）分别为每10万居民中的17.7例和26.0例。在一些州发现了凶杀死亡率（伯南布哥州每10万居民中的57.8例）和交通事故死亡率（罗赖马州每10万居民中的54.5例）的极值。凶杀死亡率与城市化密切相关（P = 0.001）。交通事故死亡率较高与较低的贫困水平（β = -0.93；P < 0.001）、较低的识字率（β = -1.16；P = 0.005）以及过去十年较大的人口增长（β = 3.10；P = 0.016）有关。
巴西的健康不平等模式表明地区和州之间存在两极分化，以及与欠发达相关的疾病和与发展相关的疾病并存，这表明需要一个致力于解决这些问题的卫生系统。
