Beltrán-Sánchez Hiram, Andrade Flavia C D
Department of Community Health Sciences at the Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, 650 Charles E. Young Dr, 41-257 CHS, Box 951772, Los Angeles, CA, 90095-1772, USA.
Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, USA.
Int J Equity Health. 2016 Nov 17;15(1):139. doi: 10.1186/s12939-016-0426-5.
Socioeconomic differences in health in Brazil are largely driven by differences in educational attainment. In this paper, we assess whether educational gradients in chronic disease prevalence have narrowed in Brazil from 1998 to 2013, a period of a booming economy accompanied by major investments in public health in the country.
Individual-level data came from the 1998, 2003 and 2008 Brazilian National Household Survey and the 2013 National Health Survey. We first evaluate age-standardized prevalence rates of chronic disease by education and second, we predict the estimated prevalence rate between those in low vs. high education to assess if relative changes in chronic disease have narrowed over time. Third, we estimate the slope index of inequality (SII) that evaluates the absolute change in the predicted prevalence of a disease between those in low vs. high education. Finally, we tested for statistically significant time trends in adult chronic disease inequalities by education.
Prevalence of diabetes and hypertension have increased over the period, whereas the prevalence of heart disease decreased. Brazilian adults with no education had higher levels of diabetes, hypertension and heart disease than those with some college or more. Adjusted prevalence for hypertension and heart disease indicate some progress in reducing educational disparities over time. However, for diabetes, adjusted results show a continuously increasing educational disparity from 1998 to 2013. By 2013, individuals with no education had about two times higher diabetes prevalence than those with higher education with larger disparity among women.
Results confirm findings from previous work that educational inequalities in health are large in Brazil but also provide evidence suggesting some improvement in narrowing these differentials in recent times. Recent policies aiming at reducing the prevalence of obesity, smoking and alcohol consumption, and increasing physical activity and consumption of fruits and vegetables may increase the overall health and wellbeing of the Brazilian population. These programs are likely to be more effective if they target those with low socioeconomic status, as they appeared to be at a higher risk of developing chronic conditions, and promote educational opportunities.
巴西健康方面的社会经济差异在很大程度上是由教育程度的差异驱动的。在本文中，我们评估了1998年至2013年期间巴西慢性病患病率的教育梯度是否有所缩小，这一时期经济蓬勃发展，该国在公共卫生方面进行了重大投资。
个体层面的数据来自1998年、2003年和2008年的巴西全国住户调查以及2013年的全国健康调查。我们首先按教育程度评估慢性病的年龄标准化患病率，其次，我们预测低教育程度者与高教育程度者之间的估计患病率，以评估慢性病的相对变化是否随时间而缩小。第三，我们估计不平等斜率指数（SII），该指数评估低教育程度者与高教育程度者之间疾病预测患病率的绝对变化。最后，我们检验了按教育程度划分的成人慢性病不平等的统计学显著时间趋势。
在此期间，糖尿病和高血压的患病率有所上升，而心脏病的患病率下降。未受过教育的巴西成年人患糖尿病、高血压和心脏病的水平高于有大学或更高学历的人。高血压和心脏病的调整患病率表明，随着时间的推移，在减少教育差距方面取得了一些进展。然而，对于糖尿病，调整后的结果显示，从1998年到2013年，教育差距持续扩大。到2013年，未受过教育的个体患糖尿病的患病率比受过高等教育的个体高出约两倍，女性之间的差距更大。
结果证实了先前研究的发现，即巴西健康方面的教育不平等现象严重，但也提供了证据表明，近年来在缩小这些差异方面有了一些改善。近期旨在降低肥胖、吸烟和饮酒患病率，增加体育活动以及水果和蔬菜消费的政策，可能会提高巴西人口的整体健康和福祉。如果这些项目针对社会经济地位较低的人群，可能会更有效，因为他们患慢性病的风险似乎更高，同时这些项目还应促进教育机会。
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