Kenya Noronha

Childhood Socioeconomic Position and Objectively Measured Physical Capability Levels in Adulthood: A Systematic Review and Meta-Analysis

Background Grip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood. Methods and Findings Relevant studies published by May 2010 were identified through literature searches using EMBASE and MEDLINE. Unpublished results were obtained from study investigators. Results were provided by all study investigators in a standard format and pooled using random-effects meta-analyses. 19 studies were included in the review. Total sample sizes in meta-analyses ranged from N = 17,215 for chair rise time to N = 1,061,855 for grip strength. Although heterogeneity was detected, there was consistent evidence in age adjusted models that lower childhood SEP was associated with modest reductions in physical capability levels in adulthood: comparing the lowest with the highest childhood SEP there was a reduction in grip strength of 0.13 standard deviations (95% CI: 0.06, 0.21), a reduction in mean walking speed of 0.07 m/s (0.05, 0.10), an increase in mean chair rise time of 6% (4%, 8%) and an odds ratio of an inability to balance for 5s of 1.26 (1.02, 1.55). Adjustment for the potential mediating factors, adult SEP and body size attenuated associations greatly. However, despite this attenuation, for walking speed and chair rise time, there was still evidence of moderate associations. Conclusions Policies targeting socioeconomic inequalities in childhood may have additional benefits in promoting the maintenance of independence in later life.

Obesity and excess mortality among the elderly in the United States and Mexico

Increasing levels of obesity could compromise future gains in life expectancy in low-and high-income countries. Although excess mortality associated with obesity and, more generally, higher levels of body mass index (BMI) have been investigated in the United States, there is little research about the impact of obesity on mortality in Latin American countries, where very the rapid rate of growth of prevalence of obesity and overweight occur jointly with poor socioeconomic conditions. The aim of this article is to assess the magnitude of excess mortality due to obesity and overweight in Mexico and the United States. For this purpose, we take advantage of two comparable data sets: the Health and Retirement Study 2000 and 2004 for the United States, and the Mexican Health and Aging Study 2001 and 2003 for Mexico. We find higher excess mortality risks among obese and overweight individuals aged 60 and older in Mexico than in the United States. Yet, when analyzing excess mortality among different socioeconomic strata, we observe greater gaps by education in the United States than in Mexico. We also find that although the probability of experiencing obesity-related chronic diseases among individuals with high BMI is larger for the U. S. elderly, the relative risk of dying conditional on experiencing these diseases is higher in Mexico.

Effect of early conditions on disability among the elderly in Latin America and the Caribbean

Poor early conditions have been associated with increasing risks of some chronic diseases during adulthood. Since chronic illnesses are known to be important risk factors for disability, poor early conditions should predict disability at older ages. In addition, recent literature suggests that poor early conditions may affect the risk of disability even in the absence of chronic illnesses. We aimed to evaluate the magnitude of differentials in the risk of being disabled according to early conditions experienced by elderly populations in Latin America and the Caribbean, and to identify the group of chronic illnesses responsible for it. We find that poor early conditions exert a strong influence on disability later in life in two ways: by increasing the risk of suffering disability-related chronic illnesses and by increasing the risks of suffering disabilities by those with chronic illnesses.

Desigualdade socioeconômica no acesso aos serviços de saúde no Brasil: um estudo comparativo entre as regiões brasileiras em 1998 e 2008

Este artigo mensura a desigualdade socioeconomica no acesso aos servicos de saude no Brasil e regioes, em 1998 e 2008. A analise controla por fatores predisponentes, capacitantes e de necessidade. Os resultados mostram um aumento das taxas de utilizacao e reducao das desigualdades no cuidado primario, especialmente entre individuos sem plano sugerindo melhora nos servicos publicos. A excecao e a utilizacao de servicos odontologicos, que ainda apresenta desigualdade elevada e maior utilizacao entre individuos com plano. Para o indicador de problema de acesso, observa-se ainda desigualdade favoravel aos ricos. Ao controlar para plano de saude, essa desigualdade se reduz consideravelmente.

Antenatal care use in Brazil and India: scale outreach and socioeconomic inequality.

This paper investigates the extent of socioeconomic inequalities in antenatal care use and related medical procedures in Brazil and India, which represent transition economies with contrasting geographical and sociocultural composition and health care provision. Concentration indices and regression analyses applied on recent Demographic Health Survey data reveal high and proportionate distribution of antenatal coverage in Brazil, whereas the Indian case present problems of both scale and equity. Inequalities in access to four or more antenatal visits are significantly pronounced in India, and in Brazil the differences are significant only for those who had six or more visits. Brazils universal healthcare model which proved effective in promoting equitable distribution of antenatal care could be implemented in India. Future interventions should emphasis quality of care in monitoring essential antenatal services especially targeting the poor and deprived communities.

Brazilian Valuation of EQ-5D-3L Health States: Results from a Saturation Study.

Background. Most EQ-5D-3L valuation studies include the same sample of health states that was used in the protocol of the original UK Measurement and Valuation of Health (MVH) study. Thus far, no studies using a time tradeoff utility elicitation method have been carried out using all 243 EQ-5D health states. Because the values and preferences regarding health outcomes differ among countries, it is essential to have country-specific data to enable local high-level decisions regarding resource allocation. This study developed a country-specific set of values for EQ-5D-3L health states. Methods. A multicentric study was conducted in 4 Brazilian areas. A probabilistic sample of the general population, aged 18 to 64 y, stratified by age and gender, was surveyed. The interview followed a revised version of the MVH protocol, in which all 243 health states were valued. Each respondent ranked and valued 7 health states using the TTO in a home interview. Results. Data were collected from 9148 subjects. The best-fitting regression model was an individual-level mixed-effects model without any interaction terms. The dimensions “Mobility” and “Usual Activities” were associated with higher losses in health state utility value. The “Anxiety/Depression” dimension was the domain that contributed to lower losses in health state utility value. Conclusions. This study generated significant insight into the Brazilian population’s health preferences that can be applied to health technology assessment and economic analyses in Brazil. This information represents an important new tool that can be used in Brazilian health policy creation and evaluation.

Inpatient care of the elderly in Brazil and India: Assessing social inequalities

The rapidly growing older adult populations in Brazil and India present major challenges for health systems in these countries, especially with regard to the equitable provision of inpatient care. The objective of this study was to contrast inequalities in both the receipt of inpatient care and the length of time that care was received among adults aged over 60 in two large countries with different modes of health service delivery. Using the Brazilian National Household Survey from 2003 and the Indian National Sample Survey Organisation survey from 2004 inequalities by wealth (measured by income in Brazil and consumption in India) were assessed using concentration curves and indices. Inequalities were also examined through the use of zero-truncated negative binomial models, studying differences in receipt of care and length of stay by region, health insurance, education and reported health status. Results indicated that there was no evidence of inequality in Brazil for both receipt and length of stay by income per capita. However, in India there was a pro-rich bias in the receipt of care, although once care was received there was no difference by consumption per capita for the length of stay. In both countries the higher educated and those with health insurance were more likely to receive care, while the higher educated had longer stays in hospital in Brazil. The health system reforms that have been undertaken in Brazil could be credited as a driver for reducing healthcare inequalities amongst the elderly, while the significant differences by wealth in India shows that reform is still needed to ensure the poor have access to inpatient care. Health reforms that move towards a more public funding model of service delivery in India may reduce inequality in elderly inpatient care in the country.

Health and economic growth among the states of Brazil from 1991 to 2000

Health status can affect economic growth through at least three mechanisms: 1) directly, through the relationship between health status and individual earnings, 2) indirectly, through the effect of health on levels of education, and 3) through physical capital investments. Poor health status causes considerable losses in individual income by decreasing labor productivity, numbers of hours worked, and participation in the labor force. These losses can affect a population’s level of wealth and contribute to decreased social well-being. The main goal of this study is to assess the relationship between health and economic growth among the Brazilian states between 1991 and 2000. In order to take into account the different epidemiological and morbidity profiles observed among the states, several health measures were selected such as infant mortality rate, hospital mortality rate in the public healthcare system due to perinatal complications, and proportion of deaths from selected causes (vascular diseases, diabetes, cancer, AIDS and other communicable diseases, homicides and ill-defined causes). Our main findings show that in Brazil health correlates positively with economic growth. We also found that decreases in infant mortality rates are closely associated with higher rates of economic growth. We found a significant negative relationship for health indicators that are related to poverty, less access to health care services and deaths from avoidable causes, such as communicable diseases and hospital mortality rates due to perinatal complications. In contrast, we found a positive and significant correlation between the proportion of deaths from diabetes and cancer, on the one hand, and economic growth, on the other.El estado de salud puede afectar el crecimiento economico mediante por lo menos tres mecanismos: directamente, a traves de la relacion entre estado de salud y rendimientos individuales; indirectamente, por el efecto de la salud sobre niveles educacionales; y por medio de inversiones en capital fisico. Las condiciones precarias de salud pueden causar perdidas considerables de renta individual, al reducir la productividad del trabajo, el numero de horas trabajadas y la participacion en la fuerza de trabajo, lo que puede afectar el nivel medio de riqueza de una poblacion, ademas de contribuir a la reduccion del nivel de bienestar social. El principal objetivo de este estudio es evaluar la relacion entre salud y crecimiento economico en los estados brasilenos. El analisis abarca el periodo entre 1991 y 2000. Para considerar diferentes perfiles epidemiologicos y de morbilidad observados entre los estados, se seleccionaron varias medidas de salud, algunas como: tasa de mortalidad infantil, tasa de mortalidad hospitalaria, debido a complicaciones perinatales, y la proporcion de muertes por las siguientes causas seleccionadas: enfermedades cardiovasculares, diabetes, cancer, Sida y otras enfermedades transmisibles, homicidios y causas mal-definidas). Los principales resultados muestran que, en Brasil, el estado de salud esta positivamente correlacionado con el crecimiento economico, existiendo una relacion negativa y significativa entre crecimiento economico e indicadores de salud que estan asociados a mayores niveles de pobreza, peor acceso a los cuidados de salud y muertes por causas evitables, algunas como enfermedades transmisibles y tasas de mortalidad, debido a complicaciones perinatales. Por otro lado, se verifico una relacion positiva y significativa entre crecimiento economico y proporcion de muertes por diabetes y cancer.

Measuring socioeconomic inequalities in the use of dental care services among older adults in Brazil

OBJECTIVES The primary objectives are to assess socioeconomic inequality in the use of dental care among older Brazilian adults and to analyse the extent to which certain determinants contribute to that inequality. METHODS A cross-sectional study using data from the National Oral Health Survey conducted in 2010. All individuals answered a structured questionnaire containing questions on their use of dental care and socioeconomic conditions and underwent a clinical oral examination by a dentist. Concentration indices were decomposed to determine the contribution of socioeconomic factors to inequalities. RESULTS Being in the fifth wealth, quintile was associated with higher odds of having recently visited a dentist (reference: 1st quintile, odds-ratio (OR) 2.26, 95% confidence interval (CI) 1.51-3.38). In addition, being in the top two quintiles of wealth was negatively associated with the use of public dental services. Having eight or more years of schooling was associated with higher odds of both having a recent dental visit and receiving preventive care (relative to having 0-3 years of education), and negatively associated with using public dental services. Results indicate pro-rich inequalities in recent dental visits and preventive dental care. Further, there was a pro-poor inequality in the use of public dental care services. CONCLUSIONS The recent use of dental care and the use of preventive care are disproportionately concentrated among wealthier older adults, whereas the use of public services is more common among poorer individuals. Wealth inequalities in dental care use were mainly explained by socioeconomic factors, such as wealth and education, rather than oral health factors, such as needing treatment or a dental prosthesis.

Logical Inconsistencies in 3 Preference Elicitation Methods for EQ-5D Health States: A Study in the Brazilian Population.

Background. Logical inconsistency for health states preferences occurs when one logically worse health state, in terms of quality of life, is ranked higher than a logically better health state. Objective. This study explores the presence of inconsistent responses for the EQ-5D health states valuations in a Brazilian population survey. It compares the level of inconsistency in 3 preference-based methods: ranking, visual analog scale (VAS), and time tradeoff (TTO). The influence of EQ-5D health state descriptions is explored by examining the distance between states using a city-block metric as an indicator of proximity. Moreover, it examines the association between formal education and the presence of inconsistencies, as well as the effect of removing inconsistent respondents on the estimation of social value sets from TTO and VAS. Methods. Data came from a valuation study with 3362 literate individuals aged between 18 and 64 years living in urban areas of Minas Gerais state, Brazil. Logical inconsistency was assessed using the percentage of inconsistent respondents and inconsistency rate. A logistic model was estimated to assess the association between formal education and the logical inconsistency. Societal preferences were estimated excluding inconsistent respondents considering city-block metric. Results. The percentage of inconsistent respondents and inconsistency rate are similar for TTO and ranking and lower for VAS. The probability of being inconsistent is higher among less educated groups in ranking and TTO. Inconsistency decreases with distance for all 3 methods. The removal of inconsistent individuals by considering city-block distance improves TTO estimation of social value sets. Conclusion. Findings suggest that removal of inconsistencies in TTO should consider city-block distance. For VAS, inconsistencies are not associated with formal education and do not affect social value set estimation.