Szwarcwald Celia Landmann, Almeida Wanessa da Silva de, Souza Júnior Paulo Roberto Borges de, Rodrigues Jéssica Muzy, Romero Dalia Elena
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2022 May 6;38Suppl 1(Suppl 1):e00124421. doi: 10.1590/0102-311X00124421. eCollection 2022.
The growth in longevity in Brazil has drawn attention to more useful population health measures to complement mortality. In this paper, we investigate socio-spatial differences in life expectancy and healthy life expectancy based on information from the Brazilian National Health Survey (PNS), 2013 and 2019. A three-stage cluster sampling with stratification of the primary sampling units and random selection in all stages was used in both PNS editions. Healthy life expectancy was estimated by Sullivan's method by sex, age, and Federated Units (UF). Severe limitations to at least one noncommunicable chronic disease (NCD) or poor self-rated health were used to define the unhealthy state. Inequality indicators and a Principal Component analysis were used to investigate socio-spatial inequalities. From 2013 to 2019, both life expectancy and healthy life expectancy increased. The analysis by UF show larger disparities in healthy life expectancy than in life expectancy, with healthy life expectancy at age 60 varying from 13.6 to 19.9 years, in 2013, and from 14.9 to 20.1, in 2019. Healthy life expectancy in the wealthiest quintile was 20% longer than for those living in the poorest quintile. Wide socio-spatial disparities were found with the worst indicators in the UF located in the North and Northeast regions, whether considering poverty concentration or health care utilization. The socio-spatial inequalities demonstrated the excess burden of poor health experienced by older adults living in the less developed UF. The development of strategies at subnational levels is essential not only to provide equal access to health care but also to reduce risk exposures and support prevention policies for adoption of health behaviors.
巴西人均寿命的增长促使人们关注更有效的人口健康衡量指标，以补充死亡率指标。在本文中，我们基于2013年和2019年巴西全国健康调查（PNS）的信息，研究了预期寿命和健康预期寿命的社会空间差异。两个版本的PNS均采用了三阶段整群抽样方法，对初级抽样单位进行分层，并在所有阶段进行随机选择。通过沙利文方法按性别、年龄和联邦单位（UF）估算健康预期寿命。使用至少一种非传染性慢性病（NCD）的严重限制或自评健康状况不佳来定义不健康状态。使用不平等指标和主成分分析来研究社会空间不平等。从2013年到2019年，预期寿命和健康预期寿命均有所增加。按联邦单位进行的分析表明，健康预期寿命的差异比预期寿命的差异更大，2013年60岁时的健康预期寿命从13.6岁到19.9岁不等，2019年从14.9岁到20.1岁不等。最富裕五分位数人群的健康预期寿命比最贫困五分位数人群长20%。无论考虑贫困集中程度还是医疗保健利用情况，在北部和东北部地区的联邦单位中发现了最糟糕指标的广泛社会空间差异。社会空间不平等表明，生活在欠发达联邦单位的老年人健康状况不佳的负担过重。在国家以下各级制定战略不仅对于提供平等的医疗保健机会至关重要，而且对于减少风险暴露和支持采用健康行为的预防政策也至关重要。
