Marcos Roberto Gonzaga

Viver mais e melhor? Estimativas de expectativa de vida saudável para a população brasileira

El objetivo de este estudio fue analizar los diferenciales en tres variaciones de esperanza de vida saludable de la poblacion envejecida en Brasil, 1998 a 2008: esperanza de vida libre de incapacidad funcional, con percepcion de buena salud y libre de enfermedades cronicas. Fue usado el metodo de Sullivan, combinando las tablas de vida del Instituto Brasileno de Geografia y Estadistica (IBGE) para 1998 y 2008 y calculos por intervalos de las prevalencias de incapacidad funcional, percepcion de salud y enfermedades cronicas de los Estudios Nacionales por Muestra de Domicilios (PNAD 1998 y 2008) de esos anos. Ademas del aumento de la esperanza de vida, se observaron aumentos significativos y similares de la esperanza de vida saludable en las dimensiones de percepcion del estado de salud e incapacidad funcional en casi todas las edades. Las mujeres presentaron mayores esperanzas de vida, en relacion a la de los hombres, sin embargo, esperan vivir mas tiempo con salud deteriorada, independientemente del indicador utilizado para medir la salud. A pesar de que la forma de medir la salud pueda variar entre los estudios, es percibida una desventaja femenina, en relacion a la esperanza de vida saludable.O objetivo deste estudo foi analisar as diferencas nas estimativas de tres variantes da expectativa de vida saudavel dos idosos no Brasil de 1998 para 2008: expectativa de vida livre de incapacidade funcional, com percepcao de saude boa e livre de doencas cronicas. Empregou-se o metodo de Sullivan, combinando as tabuas de vida do Instituto Brasileiro de Geografia e Estatistica (IBGE) para 1998 e 2008 e estimativas intervalares das prevalencias de incapacidade funcional, percepcao de saude e doencas cronicas da Pesquisa Nacional por Amostra de Domicilios (PNAD 1998 e 2008). Alem do aumento da expectativa de vida, observaram-se aumentos significativos e similares da expectativa de vida saudavel nas dimensoes de percepcao do estado de saude e incapacidade funcional em quase todas as idades. As mulheres apresentaram maiores expectativas de vida, se comparadas aos homens, porem esperaram viver por mais tempo com saude ruim, independentemente do indicador utilizado para mensurar saude. Mesmo que a forma de mensurar saude possa variar entre os estudos, dificultando comparacoes, e notavel a desvantagem feminina em relacao a expectativa de vida saudavel.This study analyzed differences in healthy life expectancy in the elderly based on three health dimensions in Brazil from 1998 to 2008: disability-free life expectancy, healthy life expectancy based on self-rated health, and chronic disease-free life expectancy. The Sullivan method was used, combining life tables from the Brazilian Institute of Geography and Statistics (IBGE) and interval estimates of the prevalence of functional disability, self-rated health, and chronic diseases according to the Brazilian National Household Sample Survey (PNAD, 1998 and 2008). Besides the increase in life expectancy, the study showed significant and similar increases in disability-free life expectancy and healthy life expectancy based on self-rated health at almost all ages. Women had higher life expectancies than men, but expected to live longer with poor health, regardless of the indicator used to measure health. Although the studies measured health differently (making comparisons difficult), women showed a consistent disadvantage in healthy life expectancy.

Estimativas do grau de cobertura e da mortalidade adulta (45q15) para as unidades da federação no Brasil entre 1980 e 2010

Objective: Assess the completeness of the DataSUS SIM death-count registry, by sex and Brazilian state, and estimate the probability of adult mortality (45q15), by sex and state, from 1980 to 2010. Methods: The study was based on mortality data obtained in the DataSUS Mortality Information System, from 1980 to 2010, and on population data from the 1980, 1991, 2000, and 2010 demographic censuses. The quality assessment of the registry data was conducted using traditional demographic and death distribution methods, and death probabilities were calculated using life-table concepts. Results: The results show a considerable improvement in the completeness of the death-count coverage in Brazil since 1980. In the southeast and south, we observed the complete coverage of the adult mortality registry, which did not occur in the previous decade. In the northeast and north, there were still places with a low coverage from 2000 to 2010, although there was a clear improvement in the quality of data. For all Brazilian states, there was a decline in the probability of adult mortality; we observed, however, that the death probability for males is much higher than that for females throughout the whole analysis period. Conclusion: The observed improvements seem to be related to investments in the public health care system and administrative procedures to improve the recording of vital events.

Estimativa de taxas de mortalidade por idade e sexo para pequenas áreas com regressão de TOPALS: uma aplicação para o Brasil em 2010

High variability in recorded vital events creates serious problems for small-area mortality estimation by age and sex. Many existing approaches to fitting local mortality schedules, including those most often used in Brazil, estimate rates by making rigid mathematical assumptions about local age patterns. Such methods assume that all areas within a larger area (for example, microregions within a mesoregion) have identically-shaped log mortality schedules by age. We propose a more flexible statistical estimation method that combines Poisson regression with the TOPALS relational model (DE BEER, 2012). We use the new method to estimate age-specific mortality rates in Brazilian small areas (states, mesoregions, microregions, and municipalities) in 2010. Results for Minas Gerais show notable differences in the age patterns of mortality between adjacent small areas, demonstrating the advantages of using a flexible functional form in regression models.

[Live longer and better? Estimates of healthy life expectancy in the Brazilian population].

El objetivo de este estudio fue analizar los diferenciales en tres variaciones de esperanza de vida saludable de la poblacion envejecida en Brasil, 1998 a 2008: esperanza de vida libre de incapacidad funcional, con percepcion de buena salud y libre de enfermedades cronicas. Fue usado el metodo de Sullivan, combinando las tablas de vida del Instituto Brasileno de Geografia y Estadistica (IBGE) para 1998 y 2008 y calculos por intervalos de las prevalencias de incapacidad funcional, percepcion de salud y enfermedades cronicas de los Estudios Nacionales por Muestra de Domicilios (PNAD 1998 y 2008) de esos anos. Ademas del aumento de la esperanza de vida, se observaron aumentos significativos y similares de la esperanza de vida saludable en las dimensiones de percepcion del estado de salud e incapacidad funcional en casi todas las edades. Las mujeres presentaron mayores esperanzas de vida, en relacion a la de los hombres, sin embargo, esperan vivir mas tiempo con salud deteriorada, independientemente del indicador utilizado para medir la salud. A pesar de que la forma de medir la salud pueda variar entre los estudios, es percibida una desventaja femenina, en relacion a la esperanza de vida saludable.O objetivo deste estudo foi analisar as diferencas nas estimativas de tres variantes da expectativa de vida saudavel dos idosos no Brasil de 1998 para 2008: expectativa de vida livre de incapacidade funcional, com percepcao de saude boa e livre de doencas cronicas. Empregou-se o metodo de Sullivan, combinando as tabuas de vida do Instituto Brasileiro de Geografia e Estatistica (IBGE) para 1998 e 2008 e estimativas intervalares das prevalencias de incapacidade funcional, percepcao de saude e doencas cronicas da Pesquisa Nacional por Amostra de Domicilios (PNAD 1998 e 2008). Alem do aumento da expectativa de vida, observaram-se aumentos significativos e similares da expectativa de vida saudavel nas dimensoes de percepcao do estado de saude e incapacidade funcional em quase todas as idades. As mulheres apresentaram maiores expectativas de vida, se comparadas aos homens, porem esperaram viver por mais tempo com saude ruim, independentemente do indicador utilizado para mensurar saude. Mesmo que a forma de mensurar saude possa variar entre os estudos, dificultando comparacoes, e notavel a desvantagem feminina em relacao a expectativa de vida saudavel.This study analyzed differences in healthy life expectancy in the elderly based on three health dimensions in Brazil from 1998 to 2008: disability-free life expectancy, healthy life expectancy based on self-rated health, and chronic disease-free life expectancy. The Sullivan method was used, combining life tables from the Brazilian Institute of Geography and Statistics (IBGE) and interval estimates of the prevalence of functional disability, self-rated health, and chronic diseases according to the Brazilian National Household Sample Survey (PNAD, 1998 and 2008). Besides the increase in life expectancy, the study showed significant and similar increases in disability-free life expectancy and healthy life expectancy based on self-rated health at almost all ages. Women had higher life expectancies than men, but expected to live longer with poor health, regardless of the indicator used to measure health. Although the studies measured health differently (making comparisons difficult), women showed a consistent disadvantage in healthy life expectancy.

Adult mortality estimates for small areas in Brazil, 1980–2010: a methodological approach

Abstract Background In recent decades, life expectancy and health status have improved considerably in Brazil. Life expectancy at birth has risen from 48 years in 1960 to over 73 years in 2010. However, the country is marked by large regional and socioeconomic inequality. Due to data limitations, incomplete coverage of vital registration systems, and errors in age declaration for both population and death counts, little is known about the level and trends in adult mortality for sub-national areas. This study aimed to study the evolution of adult mortality in small areas in Brazil from 1980 to 2010, using 45q15 as a summary measure of adult mortality across small areas in Brazil. Methods Data were obtained from the mortality database available from Datasus, a vital statistics database organised by the Brazilian Ministry of Health that contains information on deaths by age, sex, and cause from 1979 to 2010. Population censuses were used to acquire the population by age and sex for 137 comparable small areas in Brazil, as defined by the National Statistics Office, for the years 1980 to 2010. We combined traditional formal demography methods, called death distribution methods, with indirect standardisation and Bayesian statistics to produce more reliable estimates of adult mortality for the 137 small areas. Findings The results show that data quality has improved considerably across Brazil during the period of analysis, but regional variation persists. On average, completeness of death counts increased from 80% (range 50–100) in 1980–91, to 95% (73–100) in 2000–10. Estimates of adult mortality show that more developed regions in the south and southeast parts of the country have lower mortality levels than the northeast, but there is a clear convergence process. Interpretation This study indicates that the combination of traditional demographic methods to Bayesian statistics is a successful alternative to produce mortality estimates for small areas in Brazil. We also found a large improvement in the quality of mortality data in Brazil since 1980. Finally, we observe a convergence process on health status. Funding Brazilian National Counsel of Technological and Scientific Development (CNPq) and Minas Gerais Research Foundation (Fapemig).

Bayesian estimation of age-specific mortality and life expectancy for small areas with defective vital records

High sampling variability complicates estimation of demographic rates in small areas. In addition, many countries have imperfect vital registration systems, with coverage quality that varies significantly between regions. We develop a Bayesian regression model for small-area mortality schedules that simultaneously addresses the problems of small local samples and underreporting of deaths. We combine a relational model for mortality schedules with probabilistic prior information on death registration coverage derived from demographic estimation techniques, such as Death Distribution Methods, and from field audits by public health experts. We test the model on small-area data from Brazil. Incorporating external estimates of vital registration coverage though priors improves small-area mortality estimates by accounting for underregistration and automatically producing measures of uncertainty. Bayesian estimates show that when mortality levels in small areas are compared, noise often dominates signal. Differences in local point estimates of life expectancy are often small relative to uncertainty, even for relatively large areas in a populous country like Brazil.

¿Vivir más y mejor? Cálculos de esperanza de vida saludable para la población brasileña

El objetivo de este estudio fue analizar los diferenciales en tres variaciones de esperanza de vida saludable de la poblacion envejecida en Brasil, 1998 a 2008: esperanza de vida libre de incapacidad funcional, con percepcion de buena salud y libre de enfermedades cronicas. Fue usado el metodo de Sullivan, combinando las tablas de vida del Instituto Brasileno de Geografia y Estadistica (IBGE) para 1998 y 2008 y calculos por intervalos de las prevalencias de incapacidad funcional, percepcion de salud y enfermedades cronicas de los Estudios Nacionales por Muestra de Domicilios (PNAD 1998 y 2008) de esos anos. Ademas del aumento de la esperanza de vida, se observaron aumentos significativos y similares de la esperanza de vida saludable en las dimensiones de percepcion del estado de salud e incapacidad funcional en casi todas las edades. Las mujeres presentaron mayores esperanzas de vida, en relacion a la de los hombres, sin embargo, esperan vivir mas tiempo con salud deteriorada, independientemente del indicador utilizado para medir la salud. A pesar de que la forma de medir la salud pueda variar entre los estudios, es percibida una desventaja femenina, en relacion a la esperanza de vida saludable.O objetivo deste estudo foi analisar as diferencas nas estimativas de tres variantes da expectativa de vida saudavel dos idosos no Brasil de 1998 para 2008: expectativa de vida livre de incapacidade funcional, com percepcao de saude boa e livre de doencas cronicas. Empregou-se o metodo de Sullivan, combinando as tabuas de vida do Instituto Brasileiro de Geografia e Estatistica (IBGE) para 1998 e 2008 e estimativas intervalares das prevalencias de incapacidade funcional, percepcao de saude e doencas cronicas da Pesquisa Nacional por Amostra de Domicilios (PNAD 1998 e 2008). Alem do aumento da expectativa de vida, observaram-se aumentos significativos e similares da expectativa de vida saudavel nas dimensoes de percepcao do estado de saude e incapacidade funcional em quase todas as idades. As mulheres apresentaram maiores expectativas de vida, se comparadas aos homens, porem esperaram viver por mais tempo com saude ruim, independentemente do indicador utilizado para mensurar saude. Mesmo que a forma de mensurar saude possa variar entre os estudos, dificultando comparacoes, e notavel a desvantagem feminina em relacao a expectativa de vida saudavel.This study analyzed differences in healthy life expectancy in the elderly based on three health dimensions in Brazil from 1998 to 2008: disability-free life expectancy, healthy life expectancy based on self-rated health, and chronic disease-free life expectancy. The Sullivan method was used, combining life tables from the Brazilian Institute of Geography and Statistics (IBGE) and interval estimates of the prevalence of functional disability, self-rated health, and chronic diseases according to the Brazilian National Household Sample Survey (PNAD, 1998 and 2008). Besides the increase in life expectancy, the study showed significant and similar increases in disability-free life expectancy and healthy life expectancy based on self-rated health at almost all ages. Women had higher life expectancies than men, but expected to live longer with poor health, regardless of the indicator used to measure health. Although the studies measured health differently (making comparisons difficult), women showed a consistent disadvantage in healthy life expectancy.