Socioeconomic inequality in health in older adults in Brazil.

Objective: This study analyzed socioeconomic inequality in self-rated health for older adults (aged fifty or over) in Brazil. Methods: Data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). Socioeconomic inequality in self-rated health was measured using the concentration index, which was decomposed to analyze the contribution of different factors. Results: This study revealed that 11.5% of the older adults interviewed reported their health as poor and very poor. For the complete sample, the estimated concentration index, -0.2434, indicated that there is a concentration of poor and very poor self-rated health among older and poorer adults. Income, education and having a private health insurance plan are the factors that contributed most to the observed inequality. Discussion: The decomposition showed that there are avoidable inequalities in relation to socioeconomic status for older adults in Brazil. These factors can guide the formulation of social and health policies aimed at reducing health inequalities.

[Expenditures on childbirth care: a comparison of the 2004 and 2015 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil]. / Gastos com a assistência ao parto: comparação entre as coortes de nascimento de Pelotas dos anos de 2004 e 2015, Rio Grande do Sul, Brasil.

Although most childbirth care in Brazil is financed by the Brazilian Unified National Health System (SUS), there are out-of-pocket expenditures (private personal costs) involved in births. This study aims to compare maternal out-of-pocket expenditures in births of children from the Pelotas Birth Cohorts of 2004 and 2015. The study drew on information collected right after birth and at three months of age. The target variables include sociodemographic and economic data, private health plan coverage, and expenditures related to the birth. Values from 2004 were adjusted to 2015 by the general price index. There was an increase in private health plan coverage from 33.4% (95%CI: 31.9-34.9) to 45.1% (95%IC: 43.6-46.7) in the target period, directly associated with the families' socioeconomic status (p < 0.001). There was an increase in mean expenditures on hospitalization for the birth, from BRL 60.38 (SD = 288.66) to BRL 171.15 (SD = 957.07), and in additional medical expenditures, from BRL 191.60 (SD = 612.86) to BRL 1,424.80 (SD = 4,459.16) among mothers admitted to hospital under their private health plans (and there was no significant difference in these expenditures for mothers that opted for direct payment). There was an important increase in expenditures for childbirth care, especially among mothers admitted to hospital under private health plans.

Socioeconomic inequalities in obesity in Brazil.

The aim of this work was to analyze the socioeconomic inequality in overweight and obesity for the Brazilian adult population and to determine the factors that contribute the most to the observed inequality. Data from the 2013 National Health Survey (Pesquisa Nacional de Saúde - PNS) were used and the inequality was calculated using the concentration index, which was decomposed to analyze the contribution of different factors (demographic, schooling, lifestyle, sanitation, among others). The analyses were stratified by gender and region, in order to identify some heterogeneity. The results for gender showed that the inequality in overweight and obesity in men is concentrated in the richest ones, whereas, for women, the indices did not show inequality. In the analyzes per region, the results showed the same pattern for men, and differences were found for women, suggesting that overweight is more concentrated in rich women in the less developed regions (North and Northeast) and in poor women in more developed regions (South, Southeast and Midwest). Income, demographics, schooling, and lifestyles are the factors that contributed most to the observed inequality. Public policy strategies should aim to reduce such persistence of overweight and obesity, but also seek equity and equality in health.

Does greater unemployment make people thinner in Brazil?

The study seeks to analyze the impact of macroeconomic conditions on weight measures, such as BMI, overweight, obesity, and severe obesity in Brazil. We examine this relationship in the specific context of a middle-income country that differs in many aspects from the high-income countries usually considered in the literature. The study uses the microdata of VIGITEL in the period from 2006 to 2014 and the state unemployment rate as a proxy for macroeconomic conditions. The results showed that the relationship is robust and presents a procyclical pattern-increases in the unemployment rate reduce BMI, and this reduction is observed throughout the entire distribution, with statistically significant effects for measures of overweight, obesity, and severe obesity. These results agree with the findings for the United States but contradict the results found for Finland and Canada.

Gastos com a assistência ao parto: comparação entre as coortes de nascimento de Pelotas dos anos de 2004 e 2015, Rio Grande do Sul, Brasil / Expenditures on childbirth care: a comparison of the 2004 and 2015 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil / Gastos con la asistencia al parto: comparación entre las cohortes de nacimientos de Pelotas (Rio Grande do Sul, Brasil) desde el año 2004 y 2015

Resumo: Apesar de a maioria dos partos no Brasil ser financiada pelo Sistema Único de Saúde (SUS), existem gastos diretos (pessoais privados) envolvidos no nascimento. Este estudo visa a comparar o desembolso materno para financiar os partos das crianças pertencentes às coortes de nascimento de Pelotas de 2004 e 2015. Foram utilizadas informações coletadas logo após o nascimento e aos três meses de idade. As variáveis analisadas incluem informações sociodemográficas, econômicas, cobertura por plano privado de saúde e despesas relacionadas ao parto. Os valores de 2004 foram ajustados pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA). Observou-se aumento na posse de planos de saúde de 33,4% (IC95%: 31,9-34,9) para 45,1% (IC95%: 43,6-46,7) no período analisado e este esteve diretamente associado à posição econômica das famílias (p < 0,001). Ocorreu um aumento na média dos gastos com hospitalização para o parto de R$ 60,38 (DP = 288,66) para R$ 171,15 (DP = 957,07), e nos gastos adicionais com médicos de R$ 191,60 (DP = 612,86) para R$ 1.424,80 (DP = 4.459,16) entre as mães que se internaram pelo plano privado de saúde (e não houve diferença significativa nestes gastos entre as mães que optaram pelo parto particular). Houve aumento importante no gasto com a assistência ao parto principalmente entre as mães que se internaram pelo plano privado de saúde.

Abstract: Although most childbirth care in Brazil is financed by the Brazilian Unified National Health System (SUS), there are out-of-pocket expenditures (private personal costs) involved in births. This study aims to compare maternal out-of-pocket expenditures in births of children from the Pelotas Birth Cohorts of 2004 and 2015. The study drew on information collected right after birth and at three months of age. The target variables include sociodemographic and economic data, private health plan coverage, and expenditures related to the birth. Values from 2004 were adjusted to 2015 by the general price index. There was an increase in private health plan coverage from 33.4% (95%CI: 31.9-34.9) to 45.1% (95%IC: 43.6-46.7) in the target period, directly associated with the families' socioeconomic status (p < 0.001). There was an increase in mean expenditures on hospitalization for the birth, from BRL 60.38 (SD = 288.66) to BRL 171.15 (SD = 957.07), and in additional medical expenditures, from BRL 191.60 (SD = 612.86) to BRL 1,424.80 (SD = 4,459.16) among mothers admitted to hospital under their private health plans (and there was no significant difference in these expenditures for mothers that opted for direct payment). There was an important increase in expenditures for childbirth care, especially among mothers admitted to hospital under private health plans.

Resumen: A pesar de que la mayoría de los partos en Brasil esté financiado por el Sistema Único de Salud, existen gastos directos (personales privados) implicados en el nacimiento. Este estudio tiene como objetivo comparar el desembolso materno para financiar los partos de los niños, pertenecientes a las cohortes de nacimientos de Pelotas desde el 2004 al 2015. Se utilizó información recogida tras el nacimiento y a los tres meses de edad. Las variables analizadas incluyen información sociodemográfica, económica, cobertura con plan privado de salud y gastos relacionados con el parto. Los valores de 2004 se ajustaron por el Índice Nacional de Precios al Consumidor Amplio. Se observó un aumento en la posesión de planes de salud de un 33,4% (IC95%: 31,9-34,9) a un 45,1% (IC95%: 43,6-46,7) durante el período analizado y este se mostró directamente asociado a la posición económica de las familias (p < 0,001). Se produjo un aumento en la media de los gastos con hospitalización para el parto de BRL 60,38 (DE = 288,66) a BRL 171,15 (DE = 957,07), y en los gastos adicionales con médicos, de BRL 191,60 (DE = 612,86) a BRL 1.424,80 (DE = 4.459,16) entre las madres que estaban internadas por el plan privado de salud (y no hubo diferencia significativa en estos gastos entre las madres que optaron por el parto particular). Hubo un aumento importante en el gasto con asistencia al parto, principalmente, entre madres que estuvieron internadas para el parto mediante un plan privado de salud.

Crises econômicas, mortalidade de crianças e o papel protetor do gasto público em saúde / Economic crises, child mortality and the protective role of public health expenditure

Resumo O objetivo do estudo foi analisar como as crises econômicas afetam a saúde infantil a nível global e entre subgrupos de países com diferentes níveis de renda. Foram utilizados dados do Banco Mundial e da OMS para 127 países entre os anos de 1995 e 2014. Foi utilizado um modelo de efeitos fixos, avaliando o efeito da mudança em indicadores macroeconômicos (PIB per capita, taxa de desemprego e de inflação, e taxa de desconforto) na taxa de mortalidade neonatal, infantil, e de menores de cinco anos. Adicionalmente, avaliou-se a modificação do efeito da associação de acordo com a renda dos países e também a influência do gasto público em saúde nessa relação. As evidências mostraram que piores indicadores econômicos (menor PIB per capita e maiores inflação, taxa de desemprego e taxa de desconforto) estão associados com maiores taxas de mortalidade infantil. Nas subamostras por estrato de renda, observa-se a mesma relação, porém com efeitos de maior magnitude entre os países de renda baixa e média. Verificou-se ainda que um maior percentual nos gastos públicos em saúde ameniza os efeitos dos indicadores econômicos nas taxas de mortalidade infantil. Desta forma, é necessário aumentar a atenção aos efeitos nocivos das crises macroeconômicas para garantir melhorias na saúde infantil.

Abstract The aim of the study was to analyze how economic crises affect child health globally and between subgroups of countries with different levels of income. Data from the World Bank and the World Health Organization were used for 127 countries between 1995 and 2014. A fixed effects model was used, evaluating the effect of the change on macroeconomic indicators (GDP per capita, unemployment and inflation rates and misery index) in neonatal, infant and under-five mortality rates. Moreover, we evaluated whether there was a change in the association effect according to the income of the countries and also analyzed the role of public health expenditure in this association. Evidence has shown that worse economic indicators (lower GDP per capita, higher inflation, unemployment rates and misery index) are associated with higher child mortality rates. In the subsamples by income strata, the same association is observed, but with effects of greater magnitude for low- and middle-income countries. We also verified that a higher percentage in public health expenditures alleviates the effects of economic indicators on child mortality rates. Thus, more attention needs to be paid to the harmful effects of the macroeconomic crises to ensure improvements in child health.

Association of risk behaviours, socio-economic characteristics and academic progress in adolescents: an analysis of the 1993 birth cohort in Pelotas, Brazil.

To analyze how socio-economic factors and behavioural characteristics are related to the failure of academic progress. Data of the 1993 Birth Cohort of the city of Pelotas, Brazil, were analyzed using four follow-up waves. As a measure of the failure of academic progress, we used indicators of the age-grade gap. We analyzed the association of demographic, socio-economic, and behavioural characteristics. Factors associated with failure of academic progress were assessed through logistic regression. There are a higher odds of the age-grade gap when the adolescent is not white, man, of low socio-economic status, whose parents have low schooling and living in large families. In relation to risk behaviours, alcohol and tobacco consumption represent higher odds of the age-grade gap at age 18. The results show that socio-economic factors and behavioural characteristics are important predictors of academic progress. Public policies that seek to promote education should be targeted at the most vulnerable groups, decreasing the observed inequalities.

Economic crises, child mortality and the protective role of public health expenditure. / Crises econômicas, mortalidade de crianças e o papel protetor do gasto público em saúde.

The aim of the study was to analyze how economic crises affect child health globally and between subgroups of countries with different levels of income. Data from the World Bank and the World Health Organization were used for 127 countries between 1995 and 2014. A fixed effects model was used, evaluating the effect of the change on macroeconomic indicators (GDP per capita, unemployment and inflation rates and misery index) in neonatal, infant and under-five mortality rates. Moreover, we evaluated whether there was a change in the association effect according to the income of the countries and also analyzed the role of public health expenditure in this association. Evidence has shown that worse economic indicators (lower GDP per capita, higher inflation, unemployment rates and misery index) are associated with higher child mortality rates. In the subsamples by income strata, the same association is observed, but with effects of greater magnitude for low- and middle-income countries. We also verified that a higher percentage in public health expenditures alleviates the effects of economic indicators on child mortality rates. Thus, more attention needs to be paid to the harmful effects of the macroeconomic crises to ensure improvements in child health.

O objetivo do estudo foi analisar como as crises econômicas afetam a saúde infantil a nível global e entre subgrupos de países com diferentes níveis de renda. Foram utilizados dados do Banco Mundial e da OMS para 127 países entre os anos de 1995 e 2014. Foi utilizado um modelo de efeitos fixos, avaliando o efeito da mudança em indicadores macroeconômicos (PIB per capita, taxa de desemprego e de inflação, e taxa de desconforto) na taxa de mortalidade neonatal, infantil, e de menores de cinco anos. Adicionalmente, avaliou-se a modificação do efeito da associação de acordo com a renda dos países e também a influência do gasto público em saúde nessa relação. As evidências mostraram que piores indicadores econômicos (menor PIB per capita e maiores inflação, taxa de desemprego e taxa de desconforto) estão associados com maiores taxas de mortalidade infantil. Nas subamostras por estrato de renda, observa-se a mesma relação, porém com efeitos de maior magnitude entre os países de renda baixa e média. Verificou-se ainda que um maior percentual nos gastos públicos em saúde ameniza os efeitos dos indicadores econômicos nas taxas de mortalidade infantil. Desta forma, é necessário aumentar a atenção aos efeitos nocivos das crises macroeconômicas para garantir melhorias na saúde infantil.

Income-related inequality and inequity in children's health care: A longitudinal analysis using data from Brazil.

The Brazilian Unified Health System was created in the late 1980s to ensure free universal access to health care and was funded by taxes and social contributions. The persistent inequity in access to health services in favour of richer individuals in Brazil has been observed in the literature. However, to the best of our knowledge, no measurement of inequality in medicine use or private health insurance (PHI) among children has been performed with longitudinal data. This paper uses inequality indices and their decompositions to analyse the income-related inequalities/inequities in children's health care in the city of Pelotas, Brazil, using longitudinal data following children from 12 to 72 months of age. Our sample with data in all waves has between 1877 and 2638 children (varying according to outcome). We seek to answer three questions: i) How does the inequality/inequity in health care evolve as children grow up? ii) What are the main factors associated with inequality in children's health care? iii) How much of the change in inequality/inequity is explained by mobility in children's health care and income mobility? We found that inequities in health care have their beginnings in early childhood but that there was a reduction in inequity at 72 months of age. Ownership of children's PHI was associated with greater pro-rich inequity in health care. The reduction in inequality/inequity was linked to mobility in the sense that initially poorer children had greater gains in health care (a greater increase in PHI ownership and a lower reduction in medicine use). Despite this improvement among the poorest, apparently, the Brazilian public health service seems to fail to ensure equity in health care use among children, with possible long-term consequences on inequalities in health.

Associating socioeconomic position and maternal depression with the health of children: an evaluation of the 2008 Brazilian household survey. / Associação da posição socioeconômica e da depressão materna com a saúde das crianças: avaliação da PNAD 2008, Brasil.

The study analyzed the association between socioeconomic position (income), maternal depression and the health of children in Brazil, using information from the 2008 National Household Survey (PNAD/IBGE). The analysis considered the sampling design for the research and included 46,874 individuals up to the age of nine. The Poisson models were estimated for three health outcomes for children: health as reported by the parents or the responsible person, restrictions on habitual activities for health reasons and periods when they were confined to bed two weeks before the interviews in the study. The results showed an association between the mothers' depression and the three health outcomes, even after taking into account the following: socioeconomic position, maternal characteristics (health self-referral, age, level of education and smoking), age, gender, the child's race, geographical region, the situation as noted in the census and the number of residents in a household. It was found that there still exists an association between maternal depression and children's health irrespective of socioeconomic position. Therefore public policies that aim to reduce the adverse effects of maternal depression on the health of children need to also take into account the higher income segments of society.

O estudo analisou a associação entre posição socioeconômica (renda), depressão materna e saúde da criança no Brasil, utilizando informações da Pesquisa Nacional por Amostra de Domicílios 2008 (PNAD/IBGE). A análise considerou o delineamento amostral da pesquisa e incluiu 46.874 indivíduos com idade até 9 anos. Modelos Poisson foram estimados para três desfechos de saúde da criança: saúde reportada pelos pais ou responsáveis, restrição das atividades habituais por motivo de saúde e episódios de acamamento nas duas semanas anteriores à entrevista. Os resultados apontaram associação entre a depressão da mãe e os três desfechos, mesmo após o ajuste para posição socioeconômica, características maternas (saúde autorreferida, idade, escolaridade e tabagismo), idade, sexo e cor da pele da criança, além de região geográfica, situação censitária e número de moradores do domicílio. Constatou-se ainda que a associação entre depressão materna e saúde da criança independe da posição socioeconômica. Assim, políticas de saúde pública que objetivem atenuar os efeitos adversos da depressão materna sobre a saúde da criança, precisam considerar também os estratos mais elevados de renda da sociedade.

Associação da posição socioeconômica e da depressão materna com a saúde das crianças: avaliação da PNAD 2008, Brasil / Associating socioeconomic position and maternal depression with the health of children: an evaluation of the 2008 Brazilian household survey

Resumo O estudo analisou a associação entre posição socioeconômica (renda), depressão materna e saúde da criança no Brasil, utilizando informações da Pesquisa Nacional por Amostra de Domicílios 2008 (PNAD/IBGE). A análise considerou o delineamento amostral da pesquisa e incluiu 46.874 indivíduos com idade até 9 anos. Modelos Poisson foram estimados para três desfechos de saúde da criança: saúde reportada pelos pais ou responsáveis, restrição das atividades habituais por motivo de saúde e episódios de acamamento nas duas semanas anteriores à entrevista. Os resultados apontaram associação entre a depressão da mãe e os três desfechos, mesmo após o ajuste para posição socioeconômica, características maternas (saúde autorreferida, idade, escolaridade e tabagismo), idade, sexo e cor da pele da criança, além de região geográfica, situação censitária e número de moradores do domicílio. Constatou-se ainda que a associação entre depressão materna e saúde da criança independe da posição socioeconômica. Assim, políticas de saúde pública que objetivem atenuar os efeitos adversos da depressão materna sobre a saúde da criança, precisam considerar também os estratos mais elevados de renda da sociedade.

Abstract The study analyzed the association between socioeconomic position (income), maternal depression and the health of children in Brazil, using information from the 2008 National Household Survey (PNAD/IBGE). The analysis considered the sampling design for the research and included 46,874 individuals up to the age of nine. The Poisson models were estimated for three health outcomes for children: health as reported by the parents or the responsible person, restrictions on habitual activities for health reasons and periods when they were confined to bed two weeks before the interviews in the study. The results showed an association between the mothers' depression and the three health outcomes, even after taking into account the following: socioeconomic position, maternal characteristics (health self-referral, age, level of education and smoking), age, gender, the child's race, geographical region, the situation as noted in the census and the number of residents in a household. It was found that there still exists an association between maternal depression and children's health irrespective of socioeconomic position. Therefore public policies that aim to reduce the adverse effects of maternal depression on the health of children need to also take into account the higher income segments of society.

Estilos de vida saudável e autoavaliação de saúde como boa: uma análise dos dados da PNS/2013 / Healthy lifestyles and self-rated health as good: an analysis of the PNS/2013

Objetivo: Avaliar a influência de cinco estilos de vida sobre a autoavaliação da saúde como boa no Brasil. Métodos: Estudo transversal utilizando dados da Pesquisa Nacional de Saúde (PNS) realizada em 2013, com amostra de 46.785 indivíduos. O desfecho principal foi a autoavaliação de saúde como boa e utilizou-se a regressão logística para analisar os estilos de vida saudáveis associados a melhor autoavaliação de saúde. Resultados: Encontramos que o tabagismo, o consumo de álcool, a atividade física e a alimentação saudável são comportamentos que estão associados à autoavaliação de saúde. Pessoas que apresentam múltiplos comportamentos saudáveis apresentam chances maiores de avaliar positivamente sua saúde. Conclusão: Políticas de conscientização devem ser realizadas informando a população dos benefícios da adoção de hábitos de vida saudáveis.

Objective: Evaluating the influence of five lifestyles on health self-assessment as good in Brazil. Methods: Cross-sectional descriptive study using data from the National Health Survey (PNS 2013) conducted in 2013, with a sample of 46,785 individuals. The main outcome was self-rated health as good and logistic regression was used to analyze healthy lifestyles associated with better self-rated health. Results: We found that smoking, drinking, physical activity and healthy eating are behaviors that are associated with self-rated health. People who have multiple healthy behaviors are more likely to positively evaluate their health. Conclusion: Awareness policies should be carried out to inform the population of the benefits of adopting a healthy lifestyle.

[Economic determinants of the demand for importation of pharmacochemical and pharmaceutical products]. / Determinantes econômicos da demanda por importações de produtos farmoquímicos e farmacêuticos.

: This article analyzes the relationship between the demand for importation of pharmacochemical and pharmaceutical products and economic variables (exchange rate, import prices, and aggregate income) in Brazil, using monthly data from 1997-2014. The main results showed that increases in aggregate income and price reductions in imports have a positive and significant impact (elastic and inelastic, respectively) on imports. Exchange rate was only significant in the more aggregate model. Thus, aggregate income was a robust variable with strong impact on the importation of pharmacochemical and pharmaceutical products. The arguments in the literature that this industry's international trade deficit is related to a deficit in knowledge and technology and the current study's results provide evidence that as economic activity grows, there is a greater demand for this type of product. Additionally, if domestic production is insufficient, there is a need for imports, which can generate pressure on the trade deficit in the industry and contribute to Brazil's dependence on other countries.

Este artigo analisa a relação entre a demanda por importações de produtos farmoquímicos e farmacêuticos e variáveis econômicas (taxa de câmbio, preço das importações e renda agregada), no Brasil, fazendo uso de dados mensais do período 1997-2014. Os principais resultados mostraram que aumentos na renda agregada e reduções nos preços das importações têm impacto positivo e significativo, respectivamente de forma elástica e inelástica, sobre as importações. A taxa de câmbio foi significativa apenas no modelo mais agregado. Portanto, a renda agregada se mostrou uma variável bastante robusta e com forte impacto sobre as importações dos produtos farmoquímicos e farmacêuticos. Considerando os argumentos explicitados na literatura de que o déficit no comércio internacional dessa indústria se relaciona com déficit em conhecimento e tecnologia, somando aos resultados encontrados neste trabalho, há indícios de que conforme o nível de atividade econômica cresce, ocorre maior demanda por esse tipo de produto, e, não havendo produção nacional suficiente, existe necessidade de importações, o que pode gerar pressões no déficit comercial desse segmento, representando dependência do Brasil a outros países.

Este artículo analiza la relación entre la demanda de importaciones de productos farmoquímicos y farmacéuticos y las variables económicas (tasa de cambio, precio de las importaciones y renta agregada), en Brasil, utilizando datos mensuales del período 1997-2014. Los principales resultados mostraron que los aumentos en la renta agregada y las reducciones en los precios de las importaciones tienen un impacto positivo y significativo, respectivamente, de forma elástica e inelástica sobre las importaciones. La tasa de cambio fue significativa sólo en el modelo más agregado. Por tanto, la renta agregada se mostró una variable bastante robusta y con un fuerte impacto sobre las importaciones de los productos farmoquímicos y farmacéuticos. Considerando los argumentos explicitados en la literatura, acerca de que el déficit en el comercio internacional de esa industria se relaciona con el déficit en conocimiento y tecnología, sumado a los resultados hallados en este trabajo, hay indicios de que conforme el nivel de actividad económica crece, se produce una mayor demanda por ese tipo de productos, y, sin existir producción nacional suficiente, hay una necesidad de importaciones, lo que puede generar presiones en el déficit comercial de este segmento, representando la dependencia de Brasil de otros países.

The sociodemographic, behavioral, reproductive, and health factors associated with fertility in Brazil.

High fertility rates among disadvantaged subgroups are a public health problem because fertility levels significantly affect socioeconomic conditions and a population's welfare. This paper aims to analyze the sociodemographic, behavioral, and reproductive factors associated with fertility rates among Brazilian women aged between 15-49 years. A Poisson regression was used to analyze data from the 2006 PNDS (Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher), which evaluates socioeconomic, demographic, geographic, reproductive, behavioral, and chronic disease variables. The results show that the following characteristics are positively associated with an increase in the number of children born: being aged 20-24, residing in the North, being nonwhite, not being in paid employment, having lower education levels, having lower socioeconomic status, being in a stable union, having the first sexual intercourse before the age of 16 and having the first child before the age of 20. Thus, it is important to implement efficient family planning policies targeting these subgroups in order to improve life conditions, reduce inequalities and avoid the adverse outcomes of high fertility.

Determinantes econômicos da demanda por importações de produtos farmoquímicos e farmacêuticos / Economic determinants of the demand for importation of pharmacochemical and pharmaceutical products / Determinantes económicos de la demanda de importaciones de productos farmoquímicos y farmacéuticos

Resumo: Este artigo analisa a relação entre a demanda por importações de produtos farmoquímicos e farmacêuticos e variáveis econômicas (taxa de câmbio, preço das importações e renda agregada), no Brasil, fazendo uso de dados mensais do período 1997-2014. Os principais resultados mostraram que aumentos na renda agregada e reduções nos preços das importações têm impacto positivo e significativo, respectivamente de forma elástica e inelástica, sobre as importações. A taxa de câmbio foi significativa apenas no modelo mais agregado. Portanto, a renda agregada se mostrou uma variável bastante robusta e com forte impacto sobre as importações dos produtos farmoquímicos e farmacêuticos. Considerando os argumentos explicitados na literatura de que o déficit no comércio internacional dessa indústria se relaciona com déficit em conhecimento e tecnologia, somando aos resultados encontrados neste trabalho, há indícios de que conforme o nível de atividade econômica cresce, ocorre maior demanda por esse tipo de produto, e, não havendo produção nacional suficiente, existe necessidade de importações, o que pode gerar pressões no déficit comercial desse segmento, representando dependência do Brasil a outros países.

Abstract: This article analyzes the relationship between the demand for importation of pharmacochemical and pharmaceutical products and economic variables (exchange rate, import prices, and aggregate income) in Brazil, using monthly data from 1997-2014. The main results showed that increases in aggregate income and price reductions in imports have a positive and significant impact (elastic and inelastic, respectively) on imports. Exchange rate was only significant in the more aggregate model. Thus, aggregate income was a robust variable with strong impact on the importation of pharmacochemical and pharmaceutical products. The arguments in the literature that this industry's international trade deficit is related to a deficit in knowledge and technology and the current study's results provide evidence that as economic activity grows, there is a greater demand for this type of product. Additionally, if domestic production is insufficient, there is a need for imports, which can generate pressure on the trade deficit in the industry and contribute to Brazil's dependence on other countries.

Resumen: Este artículo analiza la relación entre la demanda de importaciones de productos farmoquímicos y farmacéuticos y las variables económicas (tasa de cambio, precio de las importaciones y renta agregada), en Brasil, utilizando datos mensuales del período 1997-2014. Los principales resultados mostraron que los aumentos en la renta agregada y las reducciones en los precios de las importaciones tienen un impacto positivo y significativo, respectivamente, de forma elástica e inelástica sobre las importaciones. La tasa de cambio fue significativa sólo en el modelo más agregado. Por tanto, la renta agregada se mostró una variable bastante robusta y con un fuerte impacto sobre las importaciones de los productos farmoquímicos y farmacéuticos. Considerando los argumentos explicitados en la literatura, acerca de que el déficit en el comercio internacional de esa industria se relaciona con el déficit en conocimiento y tecnología, sumado a los resultados hallados en este trabajo, hay indicios de que conforme el nivel de actividad económica crece, se produce una mayor demanda por ese tipo de productos, y, sin existir producción nacional suficiente, hay una necesidad de importaciones, lo que puede generar presiones en el déficit comercial de este segmento, representando la dependencia de Brasil de otros países.

[Inequality in Brazilian women's access to medicines for chronic diseases]. / Desigualdade no acesso a medicamentos para doenças crônicas em mulheres brasileiras.

This study aimed to assess the prevalence of access to continuous prescription drugs for a group of chronic diseases and to investigate the existence of socioeconomic inequalities in access. The data are from the Brazilian National Demographic and Health Survey on Women and Children (2006), with a sample of 15,575 women 15 to 49 years of age. Among these women, 7,717 were diagnosed with a chronic disease that required acquiring medicine and were considered eligible for the study. The dependent variable was defined as the diagnosis of a chronic disease and the need to obtain medication for treatment. Multivariate analysis used Poisson regression. Higher access was associated with residence in a rural area, having one or two chronic diseases, and higher socioeconomic status. Prevalence of access to medication was high, but the analysis revealed socioeconomic inequality in access to medicines in favor of the wealthy, while identifying the most vulnerable groups as the poorest and those with more chronic diseases.

[Poor dad, poor child? An investigation of intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State, Brazil]. / Pai pobre, filho pobre? Uma análise da mobilidade intergeracional de renda na coorte de nascimentos de 1982, Pelotas, Rio Grande do Sul, Brasil.

Brazil is one of the countries with the lowest intergenerational income mobility. This article aimed to analyze intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State. Two methods were used, intergenerational income elasticity and quantile regressions, in order to measure heterogeneity in income mobility as a function of different levels of parents' past income. The results show relatively high income mobility for Brazilian standards. The main explanation is that the data cover the children's income at a younger age (about 23 years). Quantile regressions show higher social mobility in the intermediary social stratum. The results reinforce the notion of two opposite "traps", poverty and wealth.

Desigualdade no acesso a medicamentos para doenças crônicas em mulheres brasileiras / Inequality in Brazilian women’s access to medicines for chronic diseases / Inequidad en el acceso a medicamentos para enfermedades crónicas en mujeres brasileñas

O objetivo deste trabalho foi analisar a prevalência de acesso a medicamentos para tratamento de doenças crônicas e a existência de desigualdades socioeconômicas no acesso. Os dados são da Pesquisa Nacional de Demografia e Saúde e da Mulher e da Criança de 2006, com uma amostra de 15.575 mulheres (15 a 49 anos). Dessas, 7.717 tiveram diagnóstico de doença crônica com necessidade de obtenção de medicamento e foram consideradas elegíveis para o estudo. O desfecho foi construído com base no diagnóstico de doença crônica e na necessidade de obtenção de medicamento para o tratamento. A análise ajustada foi conduzida usando-se a regressão de Poisson. Os grupos que apresentaram maior prevalência de acesso foram os domiciliados na zona rural, com uma ou duas doenças crônicas e com nível socioeconômico mais elevado. A prevalência de acesso encontrada foi alta, no entanto, as análises demonstram que existe desigualdade socioeconômica no acesso a medicamentos a favor dos mais ricos, identificando como grupo mais vulnerável aquele dos indivíduos mais pobres e com maior número de doenças crônicas.

This study aimed to assess the prevalence of access to continuous prescription drugs for a group of chronic diseases and to investigate the existence of socioeconomic inequalities in access. The data are from the Brazilian National Demographic and Health Survey on Women and Children (2006), with a sample of 15,575 women 15 to 49 years of age. Among these women, 7,717 were diagnosed with a chronic disease that required acquiring medicine and were considered eligible for the study. The dependent variable was defined as the diagnosis of a chronic disease and the need to obtain medication for treatment. Multivariate analysis used Poisson regression. Higher access was associated with residence in a rural area, having one or two chronic diseases, and higher socioeconomic status. Prevalence of access to medication was high, but the analysis revealed socioeconomic inequality in access to medicines in favor of the wealthy, while identifying the most vulnerable groups as the poorest and those with more chronic diseases.

El objetivo de este estudio fue analizar la prevalencia del acceso a los medicamentos para enfermedades crónicas y la existencia de desigualdades socioeconómicas en su acceso a los mismos. Los datos son de la Encuesta Nacional de Demografía y Salud de la Mujer y la Infancia de 2006, con una muestra de 15.575 mujeres (15-49 años). Entre éstas, 7.717 fueron diagnosticadas de enfermedad crónica con necesidad de obtener medicamentos, y fueron elegibles para este estudio. Se construyó la variable dependiente, a partir del diagnóstico de la enfermedad crónica, y de la necesidad de obtener la medicación para el tratamiento. El análisis multivariado fue realizado mediante regresión de Poisson. Los grupos que tenían mayor prevalencia de acceso estaban domiciliados en una zona rural, con una o dos enfermedades crónicas y una mejor posición socioeconómica. La prevalencia encontrada de acceso fue elevada, sin embargo, el análisis muestra que existe una desigualdad socioeconómica en el acceso a los medicamentos, en favor del grupo más rico, se identificó el grupo más pobre como más vulnerable y con mayor número de enfermedades crónicas.

Determinants of out-of-pocket health expenditure on children: an analysis of the 2004 Pelotas Birth Cohort.

BACKGROUND: The present study aimed to examine the impact of socioeconomic, demographic, and health status-related factors on out-of-pocket expenditure on health care for children. METHODS: Data were obtained from a birth cohort study conducted in the city of Pelotas, state of Rio Grande do Sul (RS), southern Brazil, in 2004. The final sample is a result of adjusts made in order to keep in the analysis only those that attended to 3 follow-ups (at 12, 24 and 48 months of age). Estimates were carried out using the Panel Data Tobit Model with random effects. RESULTS: The study showed that expenditure on medicines was 20 % less likely in those considered healthy children by their mothers and, if there was any expenditure with healthy children, the expected expenditure was reduced by 58 %. A 1 % increase in household income increased the expected expenditure on medicines by 16 %, and by 23 % in children with private health insurance coverage. CONCLUSIONS: All types of health care expenditures examined were higher for children covered by private health insurance. Although total health care expenditure was higher for children of better-off families, it represented a lower share of these families' income evidencing income inequality in health care expenditures.

Pai pobre, filho pobre? Uma análise da mobilidade intergeracional de renda na coorte de nascimentos de 1982, Pelotas, Rio Grande do Sul, Brasil / Poor dad, poor child? An investigation of intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State, Brazil / ¿Padre pobre, hijo pobre? Un análisis de la movilidad intergeneracional de ingresos en la cohorte de nacimientos de 1982, Pelotas, Rio Grande do Sul, Brasil

O Brasil é apontado como um dos países com as menores mobilidades intergeracionais de renda do mundo. O principal objetivo do artigo é analisar a mobilidade intergeracional de renda na coorte de nascimentos de 1982 em Pelotas, Rio Grande do Sul. São utilizados dois métodos de estimação: elasticidade intergeracional de renda e regressões quantílicas para mensuração de possíveis heterogeneidades na mobilidade intergeracional em função dos diferentes níveis de renda dos pais no passado. Os resultados mostram uma mobilidade intergeracional de renda relativamente alta para os padrões brasileiros. A explicação reside, sobretudo, no fato de terem sido usados dados de renda dos filhos em idade jovem, em torno de 23 anos. As análises das regressões quantílicas indicam que a maior mobilidade social acontece nas camadas sociais intermediárias. Os resultados encontrados reforçam a existência de dois polos opostos de armadilhas: armadilha da pobreza e da riqueza.

Brazil is one of the countries with the lowest intergenerational income mobility. This article aimed to analyze intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State. Two methods were used, intergenerational income elasticity and quantile regressions, in order to measure heterogeneity in income mobility as a function of different levels of parents’ past income. The results show relatively high income mobility for Brazilian standards. The main explanation is that the data cover the children’s income at a younger age (about 23 years). Quantile regressions show higher social mobility in the intermediary social stratum. The results reinforce the notion of two opposite “traps”, poverty and wealth.

Brasil está considerado como uno de los países con menor movilidad intergeneracional de ingresos del mundo. El principal objetivo de este estudio es examinar la movilidad intergeneracional de ingresos en la cohorte de nacimientos de 1982 en Pelotas, Rio Grande do Sul. Se utilizan dos métodos para la estimación: la elasticidad intergeneracional de los ingresos y regresiones por cuartiles de ingresos para los diferentes niveles de ingresos de los padres en el pasado. Los resultados sugieren una movilidad intergeneracional de ingresos relativamente alta para los estándares brasileños. La explicación radica principalmente en el hecho de que fueron utilizados datos de ingresos de los hijos cuando eran muy jóvenes, alrededor de 23 años. Los análisis de regresiones por cuartiles indican que una mayor movilidad social se produce en las capas intermedias. Los resultados refuerzan la existencia de dos polos opuestos: el de la pobreza y el de la riqueza.