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1.
Heart ; 106(1): 6-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31615851
3.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190012.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596383

RESUMO

OBJECTIVE: To evaluate the prevalence of noncommunicable disease (NCD) indicators, including laboratory tests, in the population of Brazilian women of reproductive age, according to whether or not they receive the Bolsa Família (BF) benefit. METHODS: A total of 3,131 women aged 18 to 49 years old who participated in the National Health Survey (Pesquisa Nacional de Saúde ) laboratory examination sub-sample were considered. We compared indicators among women of reproductive age (18 to 49 years old) who reported receiving BF or not, and calculated prevalence and confidence intervals, using Pearson's χ2. RESULTS: Women of reproductive age who were beneficiaries of BF had worse health outcomes, such as a greater occurrence of being overweight (33.5%) and obese (26.9%) (p < 0.001), having hypertension (13.4% versus 4.4%, p < 0.001), used more tobacco (11.2% versus 8.2%, p = 0.029), and perceived their health as worse (6.2% versus 2.4%, p < 0.001). CONCLUSION: Several NCD indicators were worse among women of childbearing age who were beneficiaries of BF. It should be emphasized that this is not a causal relationship, with BF being a marker of inequalities among women. The benefit has been directed to the population with greater health needs, and seeks to reduce inequities.


Assuntos
Doenças não Transmissíveis/epidemiologia , Assistência Pública/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Doença Crônica , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Reprodução/fisiologia , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
4.
SSM Popul Health ; 7: 015-15, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31297431

RESUMO

The literature on health inequalities often uses measures of socio-economic position pragmatically to rank the population to describe inequalities in health rather than to understand social and economic relationships between groups. Theoretical considerations about the meaning of different measures, the social processes they describe, and how these might link to health are often limited. This paper builds upon Wright's synthesis of social class theories to propose a new integrated model for understanding social class as applied to health. This model incorporates several social class mechanisms: social background and early years' circumstances; Bourdieu's habitus and distinction; social closure and opportunity hoarding; Marxist conflict over production (domination and exploitation); and Weberian conflict over distribution. The importance of discrimination and prejudice in determining the opportunities for groups is also explicitly recognised, as is the relationship with health behaviours. In linking the different social class processes we have created an integrated theory of how and why social class causes inequalities in health. Further work is required to test this approach, to promote greater understanding of researchers of the social processes underlying different measures, and to understand how better and more comprehensive data on the range of social class processes these might be collected in the future.

5.
Ethn Health ; : 1-19, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31313591

RESUMO

Objectives: We compare rates of ill health and socioeconomic inequalities in health by ethnic groups in Scotland by age. We focus on ethnic differences in socioeconomic inequalities in health. There is little evidence of how socioeconomic inequalities in health vary by ethnicity, especially in Scotland, where health inequalities are high compared to other European countries. Design: A cross-sectional study using the 2011 Scottish Census (population 5.3 million) was conducted. Directly standardized rates were calculated for two self-rated health outcomes (poor general health and limiting long-term illness) separately by ethnicity, age and small-area deprivation. Slope and relative indices of inequality were calculated to measure socioeconomic inequalities in health. Results: The results show that the White Scottish population tend to have worse health and higher socioeconomic inequalities in health than many other ethnic groups, while White Polish and Chinese people tend to have better health and low socioeconomic inequalities in health. These results are more salient for ages 30-44. The Pakistani population has high rates of poor health similar to the White Scottish for ages 15-44, but at ages 45 and above Pakistani people have the highest rates of poor self-rated health. Compared to other ethnicities, Pakistani people are also more likely to experience poor health in the least deprived areas, particularly at ages 45 and above. Conclusions: There are statistically significant and substantial differences in poor self-rated health and in socioeconomic inequalities in health between ethnicities. Rates of ill health vary between ethnic groups at any age. The better health of the younger minority population should not be taken as evidence of better health outcomes in later life. Since socioeconomic gradients in health vary by ethnicity, policy interventions for health improvement in Scotland that focus only on deprived areas may inadvertently exclude minority populations.

6.
Eur J Public Health ; 29(4): 647-655, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31220246

RESUMO

BACKGROUND: Average life expectancy has stopped increasing for many countries. This has been attributed to causes such as influenza, austerity policies and deaths of despair (drugs, alcohol and suicide). Less is known on the inequality of life expectancy over time using reliable, whole population, data. This work examines all-cause and cause-specific mortality rates in Scotland to assess the patterning of relative and absolute inequalities across three decades. METHODS: Using routinely collected Scottish mortality and population records we calculate directly age-standardized mortality rates by age group, sex and deprivation fifths for all-cause and cause-specific deaths around each census 1981-2011. RESULTS: All-cause mortality rates in the most deprived areas in 2011 (472 per 100 000 population) remained higher than in the least deprived in 1981 (422 per 100 000 population). For those aged 0-64, deaths from circulatory causes more than halved between 1981 and 2011 and cancer mortality decreased by a third (with greater relative declines in the least deprived areas). Over the same period, alcohol- and drug-related causes and male suicide increased (with greater absolute and relative increases in more deprived areas). There was also a significant increase in deaths from dementia and Alzheimer's disease for those aged 75+. CONCLUSIONS: Despite reductions in mortality, relative (but not absolute) inequalities widened between 1981 and 2011 for all-cause mortality and for several causes of death. Reducing relative inequalities in Scotland requires faster mortality declines in deprived areas while countering increases in mortality from causes such as drug- and alcohol-related harm and male suicide.

7.
Health Place ; 57: 238-246, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31125848

RESUMO

In contrast to area-based deprivation measures, commercial datasets remain infrequently used in health research and policy. Experian collates numerous commercial and administrative data sources to produce Mosaic groups which stratify households into 15 groups for marketing purposes. We assessed the potential utility of Mosaic groups for health research purposes by investigating their relationships with Indices of Multiple Deprivation (IMD) for the British population. Mosaic groups showed significant associations with IMD quintiles. Correspondence Analysis revealed variations in patterns of association, with Mosaic groups either showing increasing, decreasing, or some mixed trends with deprivation quintiles. These results suggest that Experian's Mosaics additionally measure other aspects of socioeconomic circumstances to those captured by deprivation measures. These commercial data may provide new insights into the social determinants of health at a small area level.

8.
PLoS One ; 14(3): e0214380, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30921393

RESUMO

BACKGROUND: There is a substantial gap in health and longevity between more affluent and more deprived areas, and more knowledge of the determinants of this health divide is required. Experience of the local residential environment is important for health although few studies have examined this in relation to biological markers of age such as telomere length. We sought to examine if residents' perceptions of neighbourhood stressors over time were associated with telomere length in a community study. METHODOLOGY/PRINCIPAL FINDINGS: In a prospective cohort study of 2186 adults in the West of Scotland, we measured neighbourhood stressors at three time points over a 12-year period and telomere length at the end of the study. Using linear regression models, we found that a higher accumulation of neighbourhood stressors over time was associated with shorter telomere length, even after taking cohort, social class, health behaviours (smoking status, diet, physical activity), BMI and depression into account among females only (Beta = 0.007; 95%CI [0.001, 0.012]; P<0.014). CONCLUSIONS/SIGNIFICANCE: Neighborhood environments are potentially modifiable, and future efforts directed towards improving deleterious local environments may be useful to lessen telomere attrition.


Assuntos
Estresse Psicológico , Encurtamento do Telômero , Telômero/metabolismo , Adolescente , Adulto , Índice de Massa Corporal , Dieta , Exercício , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fumar , Classe Social
9.
Arch Dis Child ; 104(10): 998-1003, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30798258

RESUMO

From birth, children living in disadvantaged socioeconomic circumstances (SECs) suffer from worse health than their more advantaged peers. The pathways through which SECs influence children's health are complex and inter-related, but in general are driven by differences in the distribution of power and resources that determine the economic, material and psychosocial conditions in which children grow up. A better understanding of why children from more disadvantaged backgrounds have worse health and how interventions work, for whom and in what contexts, will help to reduce these unfair differences. Macro-level change is also required, including the reduction of child poverty through improved social security systems and employment opportunities, and continued investment in high-quality and accessible services (eg, childcare, key workers, children's centres and healthy school environments). Child health professionals can play a crucial role by being mindful of the social determinants of health in their daily practice, and through advocating for more equitable and child-focussed resource allocation.

10.
Soc Sci Med ; 220: 353-361, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30513485

RESUMO

Internationally, policy makers are increasingly focussed on reducing the detrimental consequences and rising costs associated with unhealthy diets, inactivity, smoking, alcohol and other risk factors on the health of their populations. This has led to an increase in the demand for evidence-based, cost-effective Population Health Interventions (PHIs) to reverse this trend. Given that research designs such as randomised controlled trials (RCTs) are often not suited to the evaluation of PHIs, Natural Experiments (NEs) are now frequently being used as a design to evaluate such complex, preventive PHIs. However, current guidance for economic evaluation focusses on RCT designs and therefore does not address the specific challenges of NE designs. Using such guidance can lead to sub-optimal design, data collection and analysis for NEs, leading to bias in the estimated effectiveness and cost-effectiveness of the PHI. As a consequence, there is a growing recognition of the need to identify a robust methodological framework for the design and conducting of economic evaluations alongside such NEs. This paper outlines the challenges inherent to the design and conduct of economic evaluations of PHIs alongside NEs, providing a comprehensive framework and outlining a research agenda in this area.

11.
Rev. bras. epidemiol ; 22(supl.2): E190012.SUPL.2, 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-1042224

RESUMO

RESUMO: Objetivo: Avaliar a prevalência dos indicadores de doenças crônicas não transmíssiveis (DCNT), incluindo exames laboratoriais, na população de mulheres brasileiras em idade reprodutiva segundo o recebimento do benefício Bolsa Família (BF). Métodos: Consideraram-se as 3.131 mulheres de 18 a 49 anos que participaram da submamostra de exames laboratoriais da Pesquisa Nacional de Saúde (PNS). Foram comparados indicadores entre as mulheres em idade reprodutiva (18 a 49 anos) que disseram ter ou não Bolsa Família e calculados prevalência e intervalo de confiança (IC) usando χ2 de Pearson. Resultados: Observou-se que as mulheres em idade reprodutiva beneficiárias do BF quando comparadas às não beneficiárias têm piores desfechos em saúde, como maior ocorrência de sobrepeso (33,5%) e obesidade (26,9%) (p < 0,001), hipertensão 13,4% versus 4,4% (p < 0,001), uso de tabaco (11,2%) versus 8,2% (p = 0,029), além de 6,2% perceberem sua saúde pior, em comparação a 2,4% das mulheres não beneficiárias (p<0,001). Conclusão: Diversos indicadores de DCNT tiveram pior desempenho entre as mulheres em idade reprodutiva beneficiárias do BF. Destaca-se que essa não é uma relação causal, sendo o BF um marcador de desigualdade entre mulheres. O benefício tem sido direcionado à população com maior necessidade em saúde, buscando assim reduzir iniquidades.


ABSTRACT: Objective: To evaluate the prevalence of noncommunicable disease (NCD) indicators, including laboratory tests, in the population of Brazilian women of reproductive age, according to whether or not they receive the Bolsa Família (BF) benefit. Methods: A total of 3,131 women aged 18 to 49 years old who participated in the National Health Survey (Pesquisa Nacional de Saúde ) laboratory examination sub-sample were considered. We compared indicators among women of reproductive age (18 to 49 years old) who reported receiving BF or not, and calculated prevalence and confidence intervals, using Pearson's χ2. Results: Women of reproductive age who were beneficiaries of BF had worse health outcomes, such as a greater occurrence of being overweight (33.5%) and obese (26.9%) (p < 0.001), having hypertension (13.4% versus 4.4%, p < 0.001), used more tobacco (11.2% versus 8.2%, p = 0.029), and perceived their health as worse (6.2% versus 2.4%, p < 0.001). Conclusion: Several NCD indicators were worse among women of childbearing age who were beneficiaries of BF. It should be emphasized that this is not a causal relationship, with BF being a marker of inequalities among women. The benefit has been directed to the population with greater health needs, and seeks to reduce inequities.

12.
Rev Saude Publica ; 52: 83, 2018 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-30183845

RESUMO

OBJECTIVE: To describe and assess currently used area-based measures of deprivation in Brazil for health research, to the purpose of informing the development of a future small area deprivation index. METHODS: We searched five electronic databases and seven websites of Brazilian research institutions and governmental agencies. Inclusion criteria were: studies proposing measures of deprivation for small areas (i.e., finer geography than country-level) in Brazil, published in English, Portuguese or Spanish. After data-extraction, results were tabulated according to the area level the deprivation measure was created for and to the dimensions of deprivation or poverty included in the measures. A narrative synthesis approach was used to summarize the measures available, highlighting their utility for public health research. RESULTS: A total of 7,199 records were retrieved, 126 full-text articles were assessed after inclusion criteria and a final list of 30 articles was selected. No small-area deprivation measures that have been applied to the whole of Brazil were found. Existing measures were mainly used to study infectious and parasitic diseases. Few studies used the measures to assess inequalities in mortality and no studies used the deprivation measure to evaluate the impact of social programs. CONCLUSIONS: No up-to-date small area-based deprivation measure in Brazil covers the whole country. There is a need to develop such an index for Brazil to measure and monitor inequalities in health and mortality, particularly to assess progress in Brazil against the Sustainable Development Goal targets for different health outcomes, showing progress by socioeconomic groups.


Assuntos
Censos , Pobreza/estatística & dados numéricos , Fatores Socioeconômicos , Brasil , Humanos
13.
Artigo em Inglês | MEDLINE | ID: mdl-30154306

RESUMO

There is growing interest in understanding which aspects of the local environment influence obesity. Using data from the longitudinal West of Scotland Twenty-07 study (n = 2040) we examined associations between residents' self-reported neighbourhood problems, measured over a 13-year period, and nurse-measured body weight and size (body mass index, waist circumference, waist⁻hip ratio) and percentage body fat. We also explored whether particular measures such as abdominal obesity, postulated as a marker for stress, were more strongly related to neighbourhood conditions. Using life course models adjusted for sex, cohort, household social class, and health behaviours, we found that the accumulation of perceived neighbourhood problems was associated with percentage body fat. In cross-sectional analyses, the strongest relationships were found for contemporaneous measures of neighbourhood conditions and adiposity. When analyses were conducted separately by gender, perceived neighbourhood stressors were strongly associated with central obesity measures (waist circumference, waist⁻hip ratio) among both men and women. Our findings indicate that chronic neighbourhood stressors are associated with obesity. Neighbourhood environments are modifiable, and efforts should be directed towards improving deleterious local environments to reduce the prevalence of obesity.


Assuntos
Adiposidade , Obesidade/epidemiologia , Características de Residência , Adulto , Idoso , Índice de Massa Corporal , Peso Corporal , Estudos Transversais , Características da Família , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal , Percepção , Prevalência , Escócia/epidemiologia , Classe Social , Circunferência da Cintura , Relação Cintura-Quadril , Adulto Jovem
14.
Lancet Public Health ; 3(7): e333-e340, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29976327

RESUMO

BACKGROUND: In the UK, lone parents must seek work as a condition of receiving welfare benefits once their youngest child reaches a certain age. Since 2008, the lower age limit at which these Lone Parent Obligations (LPO) apply has been reduced in steps. We used data from a nationally representative, longitudinal, household panel study to analyse the health effects of increased welfare conditionality under LPO. METHODS: From the Understanding Society survey, we used data for lone mothers who were newly exposed to LPO when the age cutoff was reduced from 7 to 5 years in 2012 (intervention group 1) and from 10 to 7 years in 2010 (intervention group 2), as well as lone mothers who remained unexposed (control group 1) or continuously exposed (control group 2) at those times. We did difference-in-difference analyses that controlled for differences in the fixed characteristics of participants in the intervention and control groups to estimate the effect of exposure to conditionality on the health of lone mothers. Our primary outcome was the difference in change over time between the intervention and control groups in scores on the Mental Component Summary (MCS) of the 12-item Short-Form Health Survey (SF-12). FINDINGS: The mental health of lone mothers declined in the intervention groups compared with the control groups. For intervention group 1, scores on the MCS decreased by 1·39 (95% CI -1·29 to 4·08) compared with control group 1 and by 2·29 (0·00 to 4·57) compared with control group 2. For intervention group 2, MCS scores decreased by 2·45 (-0·57 to 5·48) compared with control group 1 and by 1·28 (-1·45 to 4·00) compared with control group 2. When pooling the two intervention groups, scores on the MCS decreased by 2·13 (0·10 to 4·17) compared with control group 1 and 2·21 (0·30 to 4·13) compared with control group 2. INTERPRETATION: Stringent conditions for receiving welfare benefits are increasingly common in high-income countries. Our results suggest that requiring lone parents with school-age children toseek work as a condition of receiving welfare benefits adversely affects their mental health. FUNDING: UK Medical Research Council, Scottish Government Chief Scientist Office, and National Health Service Research Scotland.


Assuntos
Nível de Saúde , Mães , Pais Solteiros , Seguridade Social/legislação & jurisprudência , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Mães/psicologia , Mães/estatística & dados numéricos , Pais Solteiros/psicologia , Pais Solteiros/estatística & dados numéricos , Reino Unido
15.
Rev. saúde pública (Online) ; 52: 83, 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-962273

RESUMO

ABSTRACT OBJECTIVE To describe and assess currently used area-based measures of deprivation in Brazil for health research, to the purpose of informing the development of a future small area deprivation index. METHODS We searched five electronic databases and seven websites of Brazilian research institutions and governmental agencies. Inclusion criteria were: studies proposing measures of deprivation for small areas (i.e., finer geography than country-level) in Brazil, published in English, Portuguese or Spanish. After data-extraction, results were tabulated according to the area level the deprivation measure was created for and to the dimensions of deprivation or poverty included in the measures. A narrative synthesis approach was used to summarize the measures available, highlighting their utility for public health research. RESULTS A total of 7,199 records were retrieved, 126 full-text articles were assessed after inclusion criteria and a final list of 30 articles was selected. No small-area deprivation measures that have been applied to the whole of Brazil were found. Existing measures were mainly used to study infectious and parasitic diseases. Few studies used the measures to assess inequalities in mortality and no studies used the deprivation measure to evaluate the impact of social programs. CONCLUSIONS No up-to-date small area-based deprivation measure in Brazil covers the whole country. There is a need to develop such an index for Brazil to measure and monitor inequalities in health and mortality, particularly to assess progress in Brazil against the Sustainable Development Goal targets for different health outcomes, showing progress by socioeconomic groups.

16.
Lancet Public Health ; 2(3): e126-e127, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-29253383

Assuntos
Pobreza
17.
Artigo em Inglês | MEDLINE | ID: mdl-29186035

RESUMO

The aim of this study was to examine changes in neighbourhood perceptions on self-rated mental health problems over time, and to explore demographic, geographic and socio-economic factors as determinants of increased or decreased anxiety and depression symptoms. We conducted a repeat cross-sectional study of individuals (N: 4480) living in the same areas of west central Scotland in 1997 and 2010. Individuals were asked to complete a questionnaire at both time-points, containing 14 questions relating to neighbourhood perceptions and the Hospital Anxiety and Depression Scale (HADS). A three-level linear regression model was fitted to HADS scores and changes in neighbourhood perceptions over time; controlling for a number of individual and area-level variables. Overall, area-level mean HADS scores decreased from 1997 to 2010. When adjusted for individual and area-level variables, this decrease did not remain for HADS anxiety. Applying an overall 14-scale neighbourhood perception measure, worsening neighbourhood perceptions were associated with small increases in depression (0.04, 95% confidence interval (CI) 0.01 to 0.07) and anxiety (0.04, 95% CI 0.00 to 0.08) scores over time. This highlights a need for local and national policy to target areas where neighbourhood characteristics are substantially deteriorating in order to ensure the mental health of individuals does not worsen.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Saúde Mental , Percepção , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escócia/epidemiologia , Autorrelato , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
18.
BMJ Open ; 7(7): e015027, 2017 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-28698325

RESUMO

PURPOSE: The Scottish school leavers cohort provides population-wide prospective follow-up of local authority secondary school leavers in Scotland through linkage of comprehensive education data with hospital and mortality records. It considers educational attainment as a proxy for socioeconomic position in young adulthood and enables the study of associations and causal relationships between educational attainment and health outcomes in young adulthood. PARTICIPANTS: Education data for 284 621 individuals who left a local authority secondary school during 2006/2007-2010/2011 were linked with birth, death and hospital records, including general/acute and mental health inpatient and day case records. Individuals were followed up from date of school leaving until September 2012. Age range during follow-up was 15 years to 24 years. FINDINGS TO DATE: Education data included all formal school qualifications attained by date of school leaving; sociodemographic information; indicators of student needs, educational or non-educational support received and special school unit attendance; attendance, absence and exclusions over time and school leaver destination. Area-based measures of school and home deprivation were provided. Health data included dates of admission/discharge from hospital; principal/secondary diagnoses; maternal-related, birth-related and baby-related variables and, where relevant, date and cause of death. This paper presents crude rates for all-cause and cause-specific deaths and general/acute and psychiatric hospital admissions as well as birth outcomes for children of female cohort members. FUTURE PLANS: This study is the first in Scotland to link education and health data for the population of local authority secondary school leavers and provides access to a large, representative cohort with the ability to study rare health outcomes. There is the potential to study health outcomes over the life course through linkage with future hospital and death records for cohort members. The cohort may also be expanded by adding data from future school leavers. There is scope for linkage to the Prescribing Information System and the Scottish Primary Care Information Resource.


Assuntos
Escolaridade , Mortalidade/tendências , Alta do Paciente/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Evasão Escolar , Adolescente , Causas de Morte , Feminino , Disparidades em Assistência à Saúde , Humanos , Modelos Logísticos , Masculino , Saúde Mental , Gravidez , Estudos Prospectivos , Escócia/epidemiologia , Fatores Socioeconômicos
20.
Data Brief ; 7: 1682-1686, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27761509

RESUMO

These data present a new small-area deprivation measure, but also include a variety of other indicators, such as the Scottish Index of Multiple Deprivation (SIMD) and the Carstairs score. The data are for Scottish 2001 Datazones and for the years 2001 and 2011. In addition the data provide standardised self-reported measures of general health and limiting long-term illness. The theoretical background for developing the new deprivation measure, and the implications of using different measures to study health inequalities are discussed in "Developing a new small-area measure of deprivation using 2001 and 2011 census data from Scotland" (Allik et al., 2016) [1].

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