Cavalini Luciana Tricai, de Leon Antonio Carlos Monteiro Ponce
Department of Epidemiology and Biostatistics, Institute of Community Health, Fluminense Federal University, Niterói, RJ, Brazil.
Int J Epidemiol. 2008 Aug;37(4):775-83. doi: 10.1093/ije/dyn088. Epub 2008 May 24.
Socioeconomic and healthcare indicators are major determinants of health outcomes. The impact of social and healthcare inequalities on Brazilian morbidity and mortality indicators is of concern but it is not well studied.
A multilevel ecological study was performed in order to investigate the association between a set of socioeconomic and healthcare indicators and five morbidity and mortality outcomes. Datasets were presented at three hierarchical levels: local (lower level), regional (intermediate level) and state (higher level). A Poisson regression model was estimated for each outcome with random intercept and fixed regression coefficients for independent variables at the three levels. The magnitude of outcome variability at intermediate and higher levels was assessed for all models.
All outcomes were associated with both socioeconomic and healthcare variables, with predominance of associations at the local level. General and high-complexity healthcare infrastructures were directly associated with indicators related to later stages of the demographic and epidemiological transition process. A mild effect on morbidity and mortality related to political voting patterns was found at the local level.
Healthcare conditions and socioeconomic indicators are associated with health outcomes in a complex way at the local level in Brazil, but part of the variability of health outcomes is related to factors operating at higher levels. Some possible interaction effects and cross-sectional design limitations of this study must be considered.
社会经济和医疗保健指标是健康结果的主要决定因素。社会和医疗保健不平等对巴西发病率和死亡率指标的影响令人担忧，但尚未得到充分研究。
进行了一项多层次生态研究，以调查一组社会经济和医疗保健指标与五种发病率和死亡率结果之间的关联。数据集呈现为三个层次级别：地方（较低级别）、区域（中级级别）和州（较高级别）。对每个结果估计了泊松回归模型，在三个级别上对自变量采用随机截距和固定回归系数。对所有模型评估了中级和较高级别结果变异性的大小。
所有结果均与社会经济和医疗保健变量相关，在地方级别关联占主导。一般和高复杂性医疗保健基础设施与人口和流行病学转变过程后期阶段相关的指标直接相关。在地方级别发现政治投票模式对发病率和死亡率有轻微影响。
在巴西地方层面，医疗保健条件和社会经济指标以复杂方式与健康结果相关，但健康结果的部分变异性与较高级别起作用的因素有关。必须考虑本研究一些可能的交互作用效应和横断面设计局限性。
