RESUMO
OBJECTIVE: To investigate the evolution of prevalence of catastrophic health expenditure in the Brazilian Federal District at three different times (2003, 2009 and 2018), as well, to identify the composition of outof- pocket expenditure in the respective years. METHOD: Time series study, using descriptive data from the Family Budget Survey. Prevalence was stratified by consumption quintiles. RESULTS: 754 households were selected as a sample in 2003, 695 in 2009 and 1,000 in 2018. Taking a 10% consumption threshold, prevalence of catastrophic expenditure was 12.3% (95%CI 9.6;14.9) in 2003, 15.3% (95%CI 12.1;18.3) in 2009 and 14.1% (95CI% 11.8;16.2) in 2018. Households with lower income had higher prevalence of catastrophic expenditure. Medicines have a greater burden on expenditure of low-income families. CONCLUSIONS: There was an increase in prevalence of catastrophic expenditure in the Federal District. Medicines were the main expense for the poorest families.
Assuntos
Doença Catastrófica , Gastos em Saúde , Pobreza , Brasil , Humanos , Gastos em Saúde/estatística & dados numéricos , Doença Catastrófica/economia , Renda , Prevalência , Características da Família , Financiamento Pessoal/estatística & dados numéricos , Fatores de TempoRESUMO
BACKGROUND/OBJECTIVES: Food prices are a crucial factor in food choices, especially for more vulnerable populations. To estimate the association between diet cost and quality, as measured by the EAT-Lancet score, across demographic groups in Brazil. METHODS: Data from the 2017/18 Household Budget Survey were used to calculate the EAT-Lancet score, comprising 14 components. Scores ranged from 0 (low adherence) to 42 (high adherence), with emphasized components (e.g., vegetables, fruits, legumes) and limited components (e.g., red meat, sugar, eggs). Results were stratified by per capita income, geographic region, and area of residence and compared using linear regression adjusted for high and low costs. In addition, the association between the EAT-Lancet score (and its emphasized and limited components) and diet cost (continuous) was analyzed for the total population and for income tertiles. RESULTS: The mean EAT-Lancet score was 18.65 points (range: 7 to 25) and the mean diet cost was BRL$0.65/100 kcal. Total scores showed no significant difference between low- and high-cost diets. However, limited intake was more pronounced in low-cost diets, while high-cost diets featured emphasized foods such as fruits, vegetables, and seafood. High-cost diets also included sugars and red meat, while unsaturated fats scored higher in low-cost diets. Each one-point increase in the EAT-Lancet score was associated with a BRL$0.38 reduction in cost, driven by lower costs in the Limited component, especially among the lowest-income strata (reductions of BRL$1.58 and BRL$1.55 in the lowest income and middle income tertiles, respectively). However, higher scores for emphasized foods increased costs (BRL$0.89) in the lowest tertile. CONCLUSIONS: Higher EAT-Lancet scores were associated with reduced diet costs, likely influenced by the lower Limited component costs in low-income groups. Emphasized foods, however, tended to increase costs, particularly among the lowest-income group. These findings suggest that the role of diet composition plays a significant role in cost differences and underscore the challenges that low-income groups face in accessing affordable, healthy diets.
Assuntos
Renda , Brasil , Humanos , Dieta Saudável/economia , Dieta/economia , Dieta/estatística & dados numéricos , Inquéritos sobre Dietas , Fatores Socioeconômicos , Feminino , Masculino , Preferências Alimentares , Frutas/economiaRESUMO
OBJECTIVE: To describe the socioeconomic and demographic characteristics of the trans population in the Baixada Santista region, São Paulo state. METHODS: This was a descriptive study involving adult trans people, selected through convenience sampling in 2023. A quantitative questionnaire was administered and in-depth interviews were conducted, which were analyzed using thematic grouping. RESULTS: A total of 237 people were recruited. Of these, 42.2% identified as trans women/travestis and 36.3% as trans men/ transmasculine; 65.4% were aged up to 29 years; 51.1% self-identified as White race/skin color; 52.7% were single; 80.5% had completed at least high school; 32.5% reported no income. Self-perception of transgender identity occurred predominantly between the ages of 10 and 19 (55.7%), with social transition beginning between the ages of 15 and 19 (41.8%). Fourteen in-depth interviews were conducted. CONCLUSION: Socioeconomic factors - education level, employment and income - are central to gender identity. Public actions and policies need to be developed and improved.
Assuntos
Entrevistas como Assunto , Fatores Socioeconômicos , Pessoas Transgênero , Humanos , Brasil , Feminino , Adulto , Masculino , Adulto Jovem , Adolescente , Pessoas Transgênero/estatística & dados numéricos , Pessoas Transgênero/psicologia , Inquéritos e Questionários , Pessoa de Meia-Idade , Criança , Identidade de Gênero , Escolaridade , Renda , Emprego/estatística & dados numéricos , TransexualidadeRESUMO
OBJECTIVE: To evaluate the heterogeneity in the consumption of fresh or minimally processed foods (FMPF) and ultra-processed foods (UPF) in the Brazilian population ≥10 years of age. METHODS: Cross-sectional study that used data from the food consumption and resident module from the 2017-2018 edition of the Family Budget Survey. Variables relating to sex, region of residence, household status and per capita family income in minimum wages were used. The outcomes were dietary participation in percentage of FMPF and UPF. Heterogeneity was assessed using random effects produced by linear mixed-effects models. RESULTS: Thirty-two random effects were obtained for the consumption of FMPF and 34 for UPF. Living in the urban area of the South and Southeast regions, as well as having a higher income were driving factors in the consumption of UPF and reducing the consumption of FMPF. Living in a rural area and having low income were mainly reducing factors in the consumption of UPF and driving factors in the consumption of FMPF. CONCLUSIONS: The consumption of UPF and FMPF was determined by the set of factors that represented easy access to these foods, whether geographic or economic such as income.
Assuntos
Fast Foods , Fatores Socioeconômicos , Humanos , Brasil , Estudos Transversais , Masculino , Feminino , Fast Foods/estatística & dados numéricos , Adolescente , Criança , Adulto , Pessoa de Meia-Idade , População Urbana/estatística & dados numéricos , População Rural/estatística & dados numéricos , Manipulação de Alimentos/estatística & dados numéricos , Adulto Jovem , Renda/estatística & dados numéricos , Comportamento Alimentar , Dieta/estatística & dados numéricos , Idoso , Inquéritos sobre Dietas , Alimento ProcessadoRESUMO
Caring for a visually impaired child can affect the caregiver's income and, in turn, the family's. Catastrophic spending resulting from increased expenses and reduced income must be taken into account, whether due to unemployment, a reduction in the number of hours worked or the difficulty of entering or reentering the job market. Given this scenario, the main objective of this study was to estimate the catastrophic spending attributed to the caregiver of blind or low-vision children in reference centers for education for the blind, ophthalmology and child health located in the city of Rio de Janeiro, Brazil, identifying which factors are associated with a higher or lower prevalence of this expenditure. It was found that 53.3% of care for blind children involved 40% or more of their income. Among the caregivers of children with low vision, catastrophic spending is milder, compromising at least 40% of income for 36.8% of the caregivers. The factors associated with a higher prevalence of catastrophic spending were the caregiver's age, the number of residents in the household, higher schooling, lower household income, renovations to the home, health insurance, taking out loans, selling assets, the number of health units where the child receives treatment and the relationship of the main caregiver. The burden placed on caregivers of visually impaired children indicates a situation of vulnerability that shows the need for access to financial and social protection mechanisms, through policies that are capable of serving this group.
O cuidado de um filho com deficiência visual pode vir a afetar a renda do cuidador e, por sua vez, a renda da família. Sob essa realidade, há de se considerar o gasto catastrófico consequente do aumento de despesas e da redução de renda, seja pelo desemprego, pela redução do número de horas trabalhadas ou pela dificuldade de (re)inserção no mercado de trabalho. Perante esse cenário, o objetivo principal deste estudo foi estimar o gasto catastrófico atribuído ao cuidador de crianças cegas ou com baixa visão em centros de referência em educação para cegos, oftalmologia e saúde infantil localizados no Município do Rio de Janeiro, Brasil, identificando quais fatores estão associados a uma maior ou menor prevalência desse gasto. Observou-se que 53,3% dos cuidados de crianças com cegueira comprometem 40% ou mais da renda. Entre os cuidadores de crianças com baixa visão, o gasto catastrófico é mais ameno, comprometendo no mínimo 40% da renda para 36,8% dos cuidadores. Os fatores associados à maior prevalência de gasto catastrófico foram idade do cuidador, número de moradores na residência, maior escolaridade, menor renda domiciliar, reformas na residência, plano de saúde, aquisição de empréstimos, venda de bens, quantidade de unidades de saúde que a criança recebe tratamento e parentesco do cuidador principal. A carga que recai sobre os cuidadores de crianças com deficiência visual indica uma situação de vulnerabilidade que mostra a necessidade de acesso aos mecanismos de proteção financeira e social, por meio de políticas que sejam capazes de atender esse grupo.
El cuidado de un niño con discapacidad visual puede impactar los ingresos del cuidador y, a su vez, de la familia. En este escenario, es necesario considerar el gasto catastrófico resultante del aumento de los gastos o la reducción de los ingresos, ya sea por desempleo, reducción del número de horas trabajadas o por la dificultad de inserción o reinserción en el mercado laboral. Ante esto, el objetivo principal de este estudio fue estimar el gasto catastrófico atribuido al cuidador de niños ciegos o con baja visión en centros de referencia en educación para ciegos, oftalmología y salud infantil, ubicados en el municipio de Río de Janeiro, Brasil, con el fin de identificar qué factores se asocian con una mayor o menor prevalencia de este gasto. Se observó que el 53,3% de los cuidados de niños con discapacidad visual comprometen más del 40% de los ingresos totales. Mientras tanto, el cuidado de niños con baja visión tiene un menor gasto catastrófico, comprometiendo menos del 40% de los ingresos según el 36,8% de los cuidadores. La mayor prevalencia de gasto catastrófico estuvo asociada a los siguientes factores: edad del cuidador, número de residentes en el hogar, mayor nivel de estudios, bajos ingresos familiares, remodelaciones en el hogar, seguro de salud, adquisición de préstamos, venta de bienes, cantidad de centros de salud en las que el niño acude al tratamiento y parentesco del cuidador principal. Los cuidadores de niños con discapacidad visual enfrentan una situación de vulnerabilidad, lo que apunta a una necesidad de acceder a acciones de protección financiera y social mediante políticas dirigidas a esta población.
Assuntos
Cuidadores , Gastos em Saúde , Fatores Socioeconômicos , Humanos , Brasil , Estudos Transversais , Cuidadores/economia , Masculino , Feminino , Criança , Adulto , Gastos em Saúde/estatística & dados numéricos , Pré-Escolar , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Efeitos Psicossociais da Doença , Renda/estatística & dados numéricosRESUMO
BACKGROUND: Low back pain is a severe global health problem. To face this issue, testing interventions using rigorously performed randomized controlled trials is essential. However, it is unclear if a country's income level is related to the quality of trials conducted. OBJECTIVE: To compare the frequency and methodological quality of randomized controlled trials of physical therapy interventions for low back pain conducted in countries with different income levels. METHODS: This meta-epidemiological study retrieved trials from the Physiotherapy Evidence Database (PEDro), Literatura Latino Americana em Ciências da Saúde (LILACS), and Scientific Electronic Library Online (SciELO). The methodological quality was evaluated using the 0-10 PEDro scale. Then we calculated the mean differences with a 95% confidence interval and performed an ANOVA test with Bonferroni correction to compare the PEDro scores between income groups. RESULTS: We included 2552 trials; 70.4% were conducted in high-income countries. The mean (standard deviation) PEDro score of all trials was 5.5 (0.03) out of 10. Trials from low- or lower-middle-income countries had lower methodological quality than those from upper-middle- and high-income countries, but the mean difference was small (-0.6 points (95% CI -0.9, -0.3), and -0.7 points (95% CI -1.1, -0.5) respectively). CONCLUSION: Income level influences the methodological quality of trials of physical therapy intervention but is not the only factor. Implementing strategies to improve the methodological rigor of trials in patients with low back pain is necessary in all countries, regardless of income level.
Assuntos
Dor Lombar , Modalidades de Fisioterapia , Humanos , Ensaios Clínicos como Assunto , Estudos Epidemiológicos , Renda , Dor Lombar/terapia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: No consensus exists about the role of head circumference in identifying children at risk of suboptimal development. The objective of this study was to evaluate the association between head circumference and intelligence, schooling, employment, and income. The review 1) summarizes the overall evidence and 2) restricts the evidence to a subset of articles that met minimum quality criteria. METHODS: PubMed, Web of Science, PsycINFO, LILACS, CINAHL, WHO Institutional Repository for Information Sharing and UNICEF Innocenti were searched to identify published studies. Cohort, case-control or cross-sectional studies which evaluated the associations of interest in the general population, premature babies, babies with low birth weight or small for gestational age were included; head circumference must have been measured before the age of 20 years. Two reviewers independently performed study selection, data extraction and quality assessments. RESULTS: Of 2521 records identified, 115 were included and 21 met the minimum quality criteria. Ninety studies investigated if early measures of head circumference predict later outcomes and 25 studies measured head circumference and the outcome at the same timepoint; 78 studies adjusted the head circumference for age and sex. We identified large heterogeneity and inconsistency in the effect measures and data reported across studies. Despite the relatively large number of included articles, more than 80% presented serious limitations such as lack of adjustment for confounding and severe selection bias. Considering the subset of articles which met the minimum quality criteria, 12 of 16 articles showed positive association between head circumference and intelligence in the general population. However, in premature babies, 2 of 3 articles showed no clear effect. Head circumference was positively associated with academic performance in all investigated samples (5 of 5 articles). No article which evaluated educational attainment and employment met the minimum quality criteria, but the association between head circumference and these outcomes seems to be positive. CONCLUSIONS: Larger head circumferences are positively associated with higher levels of intelligence and academic performance in the general population, but there is evidence of non-linearity in those associations. Identifying a group of children in higher risk for worse outcomes by a simple and inexpensive tool could provide an opportunity to mitigate these negative effects. Further research is needed for a deeper understanding of the whole distribution of head circumference and its effect in premature babies. Authors should consider the non-linearity of the association in the data analysis. TRIAL REGISTRATION: Association between head circumference and intelligence, educational attainment, employment, and income: A systematic review, CRD42021289998 .
Assuntos
Cefalometria , Emprego , Cabeça , Renda , Inteligência , Humanos , Cabeça/anatomia & histologia , Criança , Escolaridade , Recém-Nascido , Pré-Escolar , LactenteRESUMO
OBJECTIVE: To describe the distribution of nutritional status and food insecurity among the adult transgender population in the Baixada Santista region of the state of São Paulo and to identify associated factors. METHODS: This was a cross-sectional study using data from the research project entitled Mapping the Transgender Population in Baixada Santista of the state of São Paulo, conducted through a structured questionnaire administered between August and December 2023. The outcomes were nutritional status and food and nutrition insecurity (FNI). The association analysis was performed using Fisher's exact test. RESULTS: A total of 237 people took part in the study. High prevalence of FNI was associated with an income of less than 2 minimum wages (p < 0.001), difficulty finding a job (p < 0.001) and lack of family support related to gender (p = 0.001). Difficulty reading/writing (p = 0.025) and proximity to an open-air market (p = 0.033) were negatively or positively associated with adequate nutritional status, respectively. CONCLUSION: The high prevalence of FNI among the most vulnerable population and the adequate nutritional status associated with proximity to open-air markets indicate the need for policies aimed at reducing inequities and expand access to adequate food.
MAIN RESULTS: The high prevalence of FNI was associated with low income, difficulty finding a job and lack of family support. Adequate nutritional status among the transgender population analyzed was associated with proximity to open-air markets. IMPLICATIONS FOR SERVICES: Service teams should incorporate the assessment of nutritional status and food and nutrition security into their routine practices in order to provide adequate service that addresses the demands and social situation of the transgender people they serve. PERSPECTIVES: There is a need for public policies aimed at reducing socioeconomic disparities exacerbated by discrimination against transgender people and facilitating access to establishments that offer diverse and quality food.
Assuntos
Insegurança Alimentar , Estado Nutricional , Fatores Socioeconômicos , Pessoas Transgênero , Humanos , Estudos Transversais , Brasil/epidemiologia , Adulto , Masculino , Feminino , Pessoas Transgênero/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem , Prevalência , Populações Vulneráveis/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , RendaRESUMO
BACKGROUND: Structural income inequality - the uneven income distribution across regions or countries - could affect brain structure and function, beyond individual differences. However, the impact of structural income inequality on the brain dynamics and the roles of demographics and cognition in these associations remains unexplored. METHODS: Here, we assessed the impact of structural income inequality, as measured by the Gini coefficient on multiple EEG metrics, while considering the subject-level effects of demographic (age, sex, education) and cognitive factors. Resting-state EEG signals were collected from a diverse sample (countries = 10; healthy individuals = 1394 from Argentina, Brazil, Colombia, Chile, Cuba, Greece, Ireland, Italy, Turkey and United Kingdom). Complexity (fractal dimension, permutation entropy, Wiener entropy, spectral structure variability), power spectral and aperiodic components (1/f slope, knee, offset), as well as graph-theoretic measures were analysed. FINDINGS: Despite variability in samples, data collection methods, and EEG acquisition parameters, structural inequality systematically predicted electrophysiological brain dynamics, proving to be a more crucial determinant of brain dynamics than individual-level factors. Complexity and aperiodic activity metrics captured better the effects of structural inequality on brain function. Following inequality, age and cognition emerged as the most influential predictors. The overall results provided convergent multimodal metrics of biologic embedding of structural income inequality characterised by less complex signals, increased random asynchronous neural activity, and reduced alpha and beta power, particularly over temporoposterior regions. CONCLUSION: These findings might challenge conventional neuroscience approaches that tend to overemphasise the influence of individual-level factors, while neglecting structural factors. Results pave the way for neuroscience-informed public policies aimed at tackling structural inequalities in diverse populations.
Assuntos
Encéfalo , Eletroencefalografia , Humanos , Masculino , Feminino , Encéfalo/fisiologia , Adulto , Eletroencefalografia/métodos , Eletroencefalografia/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem , Cognição/fisiologia , Renda/estatística & dados numéricos , IdosoRESUMO
BACKGROUND: Research, mainly conducted in Europe and North America, has shown an inequitable burden of internalising mental health problems among adolescents from poorer households. We investigated whether these mental health inequalities differ across a diverse range of countries and multiple measures of economic circumstances. METHODS: In this longitudinal observational cohort study, we analysed data from studies conducted in eight countries (Australia, Ethiopia, India, Mexico, Peru, South Africa, the UK, and Viet Nam) across five global regions. All studies had self-reported measures of internalising symptoms using a validated scale at two timepoints in adolescence; a measure of household income, household consumption expenditure, or subjective wealth; and data collected between 2000 and 2019. Household income (measured in four countries), consumption expenditure (six countries), and adolescents' subjective assessment of household wealth (five countries) were measured in mid-adolescence (14-17 years). The primary outcome (internalising symptoms, characterised by negative mood, affect, and anxiety) was measured later in adolescence between age 17 and 19 years. Analyses were linear regression models with adjustment. Effect estimates were added to random-effects meta-analyses to aid understanding of cross-country differences. FINDINGS: The overall pooled sample of eight studies featured 18â910 adolescents (9568 [50·6%] female and 9342 [49·4%] male). Household income had a small or null association with adolescents' internalising symptoms. Heterogeneity (I2 statistic) was 71·04%, falling to 39·71% after adjusting for baseline symptoms. Household consumption expenditure had a stronger association with internalising symptoms (decreases of 0·075 SD in Peru [95% CI -0·136 to -0·013], 0·034 SD in South Africa [-0·061 to -0·006], and 0·141 SD in Viet Nam [-0·202 to -0·081] as household consumption expenditure doubled). The I2 statistic was 74·24%, remaining similar at 74·83% after adjusting for baseline symptoms. Adolescents' subjective wealth was associated with internalising symptoms in four of the five countries where it was measured. The I2 statistic was 57·09% and remained similar after adjusting for baseline symptoms (53·25%). We found evidence for cross-country differences in economic inequalities in adolescents' internalising symptoms, most prominently for inequalities according to household consumption expenditure. Subjective wealth explained greater variance in symptoms compared with the objective measures. INTERPRETATION: Our study suggests that economic inequalities in adolescents' mental health are prevalent in many but not all countries and vary by the economic measure considered. Variation in the magnitude of inequalities suggests that the wider context within countries plays an important role in the development of these inequalities. FUNDING: Wellcome Trust.
Assuntos
Fatores Socioeconômicos , Humanos , Adolescente , Masculino , Feminino , Estudos Longitudinais , Reino Unido/epidemiologia , México/epidemiologia , África do Sul/epidemiologia , Peru/epidemiologia , Austrália/epidemiologia , Índia/epidemiologia , Etiópia/epidemiologia , Vietnã/epidemiologia , Adulto Jovem , Renda/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Ansiedade/epidemiologiaRESUMO
This article aims to evaluate the sociodemographic determinants of ultra-processed foods (UPF) consumption in the Brazilian population ≥ 10 years of age. The study used data from the personal and resident food consumption module of the Family Budget Surveys, grouping foods according to the NOVA classification of food processing. The classification and regression tree (CART) was used to identify the factors determining the lowest to highest percentage participation of UPF in the Brazilian population. UPF accounted for 37·0 % of energy content in 2017-2018. In the end, eight nodes of UPF consumption were identified, with household situation, education in years, age in years and per capita family income being the determining factors identified in the CART. The lowest consumption of UPF occurred among individuals living in rural areas with less than 4 years of education (23·78 %), while the highest consumption occurred among individuals living in urban areas, < 30 years of age and with per capita income ≥ US$257 (46·27 %). The determining factors identified in CART expose the diverse pattern of UPF consumption in the Brazilian population, especially conditions directly associated with access to these products, such as penetration in urban/rural regions. Through the results of this study, it may be possible to identify focal points for action in policies and actions to mitigate UPF consumption.
Assuntos
Fast Foods , Manipulação de Alimentos , População Rural , Fatores Socioeconômicos , Humanos , Brasil , Adulto , Fast Foods/estatística & dados numéricos , Feminino , Masculino , Pessoa de Meia-Idade , Adolescente , Criança , Adulto Jovem , População Rural/estatística & dados numéricos , Dieta , População Urbana/estatística & dados numéricos , Renda , Comportamento Alimentar , Escolaridade , Características da Família , Alimento ProcessadoRESUMO
There is a strong, bidirectional association between social disadvantage and poor mental health. The risk of experiencing mental health problems is particularly enhanced by factors associated with living in poverty. Thus, economic interventions may be effective in reducing the burden of mental health issues in these populations. This article explores the evidence based on one specific type of economic intervention on mental health, that is, supplementing household income through cash transfers. This narrative evidence is supplemented by an in-depth analysis of one of the world's largest national cash transfer programs, the Bolsa Família program, in Brazil. We report that evidence from multiple contexts clearly demonstrates that cash transfers are highly effective in reducing the burden of mental health issues and reducing mental health disparities. We then consider the specific mechanisms through which cash transfers influence mental health. Finally, we discuss the need for these interventions and, referring to the Brazilian case study, explore potential strategies for their implementation at scale and the implications for research and policy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Assuntos
Transtornos Mentais , Humanos , Transtornos Mentais/prevenção & controle , Transtornos Mentais/economia , Brasil , Pobreza , Renda , Saúde MentalRESUMO
OBJECTIVE: This study aimed to examine whether education level and income trajectories influence vegetable consumption changes over 13 years among civil servants at different campuses of a university in the state of Rio de Janeiro, Brazil. METHODS: Vegetable intake frequency (daily and non-daily consumption), income (per capita), and education level (maintenance of low schooling/ upward mobility/maintenance of high schooling) were assessed at baseline (1999) and in the fourth wave (2011-12) of the Pró-Saúde (Pro-Health) cohort study. A total of 2,381 participants were analyzed. The association between educational and income trajectories and variation in vegetable consumption was assessed via crude and age-adjusted generalized linear models, stratified by sex. RESULTS: Men in upward educational mobility showed a 0.5% increase in vegetable consumption (p=0.01), while women in this group demonstrated a 2.5% increase (p=0.05). Adjusted models showed that women who reduced their income had a lower likelihood of consuming vegetables (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.89-0.97). CONCLUSIONS: The findings highlight the influence of social inequalities on vegetable consumption in adults.
Assuntos
Escolaridade , Renda , Verduras , Humanos , Masculino , Feminino , Brasil , Adulto , Renda/estatística & dados numéricos , Seguimentos , Pessoa de Meia-Idade , Fatores de Tempo , Dieta/estatística & dados numéricos , Fatores Socioeconômicos , Comportamento Alimentar , Adulto JovemRESUMO
OBJECTIVE: This analysis assessed the association between regional income, screening coverage for cervical and breast cancer, and temporal trends in mortality from these cancers in different Brazilian health regions. STUDY DESIGN: Spatiotemporal ecological study across 450 health regions of Brazil. METHODS: Data from 2010 Demographic Census were used to assess income. Variations in income distribution within health regions were measured using the Gini index. Data on screening coverage were obtained from the Ambulatory Information System (SIA/SUS). Mortality was assessed from the Global Burden of Disease Study 2019 data. The average annual percentage change (AAPC) in cervical and breast cancer mortality rates, 2010-2018, was calculated by health regions. Results were presented in regional maps. The associations between income, screening coverage and mortality changes were estimated by bivariate spatial correlation. RESULTS: Health regions located in the South and Southeast regions of Brazil had the greatest percentages of screening coverage and highest per capita incomes with the lowest Gini index values. From 2010 to 2018, mortality rates for cervical cancer were highest in the North and Northeast health regions. Breast cancer mortality rates were highest in the South and Southeast health regions. The AAPC in breast and cervical cancer mortality had a negative association with per capita income and screening coverage, and a positive association with the Gini index. CONCLUSIONS: There are large regional variations in income, screening coverage, and mortality rates for women with breast and cervical cancer. These inequities could be mitigated by policies to address income disparities and improved access to screening.
Assuntos
Neoplasias da Mama , Detecção Precoce de Câncer , Neoplasias do Colo do Útero , Humanos , Brasil/epidemiologia , Neoplasias do Colo do Útero/mortalidade , Feminino , Neoplasias da Mama/mortalidade , Detecção Precoce de Câncer/estatística & dados numéricos , Adulto , Política Pública , Pessoa de Meia-Idade , Renda/estatística & dados numéricos , Fatores Socioeconômicos , Análise Espaço-TemporalRESUMO
An extensive literature has focused on the association between human, social, and economic capital and better immigrant economic attainment, and how these characteristics contribute to stratification among members of the same group. However, few studies have explored how racialization processes contribute to these within-group differences. We examine the role of intragroup differences in skin tone in stratifying outcomes among Mexican immigrants in the early twentieth century. We create a new dataset of 1910-1940 Mexican border-crossing records that we then link to the U.S. 1940 census. We use characteristics at entry to predict income in 1940 and find that-in line with dominant assimilation theories-standard measures of capital are associated with within-group attainment differences. However, we also find skin tone to be a source of within-group stratification: being perceived as having darker skin is associated with lower subsequent economic attainment than being perceived as having lighter skin. Furthermore, whereas human and social capital transcended context to allow migrants to transfer those skills anywhere, the effect of skin tone was significant only in Texas and not in other major receiving places like California. We argue that although standard measures of assimilation typically predict later outcomes, the stratifying effect of skin tone has long been a feature of Mexican immigration.
Assuntos
Emigrantes e Imigrantes , Americanos Mexicanos , Humanos , Masculino , Feminino , Americanos Mexicanos/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Adulto , Pigmentação da Pele , Fatores Socioeconômicos , México/etnologia , Estados Unidos , Renda/estatística & dados numéricos , Aculturação , Pessoa de Meia-Idade , Capital Social , Fatores Sociodemográficos , População Norte-AmericanaRESUMO
The objective of this study was to identify indicators of social inequalities associated with mortality from neoplasms in the Brazilian adult population. A scoping review method was used, establishing the guiding question: What is the effect of social inequalities on mortality from neoplasms in the Brazilian adult population? A total of 567 papers were identified, 22 of which were considered eligible. A variety of indicators were identified, such as the Human Development Index and the Gini Index, which primarily assessed differences in income, schooling, human development and vulnerability. A single pattern of association between the indicators and the different neoplasms was not established, nor was a single indicator capable of explaining the effect of social inequality at all levels of territorial area and by deaths from all types of neoplasms identified. It is known that mortality is influenced by social inequalities and that the study of indicators provides an opportunity to define which best explains deaths. This review highlights important gaps regarding the use of non-modifiable social indicators, analysis of small geographical areas, and limited use of multidimensional indicators.
O objetivo deste estudo foi identificar indicadores de desigualdades sociais associados à mortalidade por neoplasias na população adulta brasileira. Utilizou-se como método a revisão de escopo, estabelecendo-se a pergunta norteadora: qual o efeito das desigualdades sociais na mortalidade por neoplasias na população adulta brasileira? Foram identificados 567 trabalhos, sendo 22 considerados elegíveis. Identificou-se uma diversidade de indicadores, como o Índice de Desenvolvimento Humano e o Índice de Gini, entre outros, que avaliaram primordialmente diferenças de renda, escolarização, desenvolvimento humano e vulnerabilidade. Não foi estabelecido um único padrão de associação entre os indicadores e as diferentes neoplasias, assim como não se identificou um indicador único capaz de explicar o efeito da desigualdade social em todos os níveis de área e por óbitos por todos os tipos de neoplasias, mas identificou-se que a mortalidade é influenciada pelas desigualdades sociais e que o estudo dos indicadores proporciona definir qual melhor explica os óbitos. Essa revisão destaca importantes lacunas referentes ao uso de indicadores sociais não modificáveis, à análise de pequenas áreas e ao uso limitado de indicadores multidimensionais.
Assuntos
Neoplasias , Fatores Socioeconômicos , Humanos , Brasil/epidemiologia , Neoplasias/mortalidade , Adulto , Desigualdades de Saúde , Disparidades nos Níveis de Saúde , RendaRESUMO
BACKGROUND: Type 2 diabetes has economic implications involving family income and out-of-pocket spending. OBJECTIVE: Determine family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income. MATERIAL AND METHODS: Study of family out-of-pocket spending in families with patients with type 2 diabetes treated at primary care level. Out-of-pocket expenses included expenses for transportation, food-drinks, and external medications. Family income corresponded to the total economic income contributed by family members. The percentage of out-of-pocket spending in relation to family income was identified with the relationship between these two variables. Statistical analysis included averages and percentages. RESULTS: The annual family out-of-pocket expenditure on transportation was $2,621.24, the family out-of-pocket expenditure on food and beverages was $1,075.67, and the family out-of-pocket expenditure on external medications was $722.08. The total annual family out-of-pocket expense was $4,418.89 and corresponds to 4.73% of family income. CONCLUSION: The family out-of-pocket expense in the family with a patient with diabetes mellitus 2 was $4,418.89 and represents 4.73% of the family income.
ANTECEDENTES: La diabetes tipo 2 tiene implicaciones económicas en el ingreso familiar y el gasto de bolsillo. OBJETIVO: Determinar el gasto de bolsillo familiar en la atención de la diabetes mellitus tipo 2 y el porcentaje que representa en el ingreso familiar. MATERIAL Y MÉTODOS: Estudio de gasto de bolsillo de las familias con pacientes con diabetes tipo 2 atendidos en el primer nivel de atención. El gasto de bolsillo familiar incluyó gasto en traslado, alimentos-bebidas y medicamentos externos. El ingreso familiar correspondió al total de ingresos económicos aportados por los miembros de la familia. El porcentaje del gasto de bolsillo con relación al ingreso familiar se identificó con la relación entre estas dos variables. El análisis estadístico incluyó promedios y porcentajes. RESULTADOS: El gasto de bolsillo familiar anual en transporte fue de $2621.24, en alimentos y bebidas fue de $1075.67 y en medicamentos externos fue de $722.08. El gasto familiar de bolsillo total anual fue de $4418.89 y correspondió a 4.73 % del ingreso familiar. CONCLUSIÓN: El gasto de bolsillo en las familias con un paciente con diabetes mellitus tipo 2 fue de $4418.89 y representó 4.73 % del ingreso familiar.
Assuntos
Diabetes Mellitus Tipo 2 , Gastos em Saúde , Renda , Humanos , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/terapia , Gastos em Saúde/estatística & dados numéricos , Masculino , Feminino , Atenção Primária à Saúde/economia , Pessoa de Meia-Idade , Família , Efeitos Psicossociais da DoençaRESUMO
Introducción. La calidad de la alimentación es un derecho vinculado con la supervivencia, el crecimiento saludable, la prevención de enfermedades crónicas y malnutrición en todas sus formas. El objetivo de este trabajo fue analizar las prácticas de lactancia y de alimentación de menores de 2 años de áreas urbanas de la Argentina en 2018-19, según el nivel de ingreso de los hogares. Población y métodos. Estudio secundario con datos de la 2da. Encuesta Nacional de Nutrición y Salud 2018-19. Se analizaron indicadores de lactancia y alimentación complementaria, según metodología de la Organización Mundial de la Salud (OMS) y Unicef. Se estratificó según nivel de ingresos del hogar. Resultados. El análisis incluyó 5763 menores de 24 meses. Aunque el 97 % fue alguna vez amamantado, solo el 47 % de los menores de 6 meses tuvo lactancia exclusiva el día previo y el 48 % mantenía la lactancia luego del año, con mayor prevalencia en los niños/as de menores ingresos. En el día previo, el 23 % de los niños/as de 6 a 23 meses no consumió ninguna verdura o fruta; el 60 % consumió alimentos no saludables y el 50 %, bebidas dulces. Las bebidas dulces y la ausencia de frutas y verduras fueron mayores en aquellos de hogares de menores ingresos. Conclusión. La calidad de la alimentación de los niños/as dista de las recomendaciones y está condicionada por los ingresos. En los sectores empobrecidos, es menor el inicio temprano de la lactancia, la diversidad alimentaria mínima y el consumo de frutas y verduras, y es mayor el consumo de bebidas dulces.
Introduction. Diet quality is a right related to survival, healthy growth, prevention of chronic diseases, and malnutrition in all its forms. The objective of this study was to analyze breastfeeding and feeding practices in children younger than 2 years from urban areas of Argentina in 20182019 according to their household income level. Population and methods. Secondary analysis of data of the Second National Survey on Nutrition and Health (ENNyS2) of 20182019. Breastfeeding and complementary feeding indicators proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) were analized. Data were stratified by household income level. Results. The analysis included 5763 children younger than 24 months old. Although 97% was ever breastfed, only 47% of infants younger than 6 months were exclusively breastfed the previous day and 48% continued with breastfeeding after 1 year old, with a higher prevalence in low-income children. The previous day, 23% of children aged 6 to 23 months did not eat any fruit or vegetable, 60% consumed unhealthy foods, and 50% consumed sweet beverages. The consumption of sweet beverages and the absence of fruit and vegetables were higher in low-income households. Conclusion. The quality of children's diet is far from the recommendations and is conditioned by income. Early initiation of breastfeeding, minimum dietary diversity, fruit and vegetable consumption are lower and sweet beverage consumption is greater in impoverished sectors.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Aleitamento Materno/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição do Lactente , Argentina , Fatores Socioeconômicos , Dieta/estatística & dados numéricos , RendaRESUMO
This article aims to assess the association between household demographic and socioeconomic characteristics and catastrophic health expenditure (CHE) in Argentina during 2017-2018. CHE was estimated as the proportion of household consumption capacity (using both income and total consumption in separate estimations) allocated for Out-of-Pocket (OOP) health expenditure. For assessing the determinants, we estimated a generalized ordered logit model using different intensities of CHE (10%, 15%, 20% and 25%) as the ordinal dependent variable, and socioeconomic, demographic and geographical variables as explanatory factors. We found that having members older than 65 years and with long-term difficulties increased the likelihood of incurring CHE. Additionally, having an economically inactive household head was identified as a factor that increases this probability. However, the research did not yield consistent results regarding the relationship between public and private health insurance and consumption capacity. Our results, along with the robustness checks, suggest that the magnitude of the coefficients for the household head characteristics could be exaggerated in studies that overlook the attributes of other household members. In addition, these results emphasize the significance of accounting for long-term difficulties and indicate that omitting this factor could overestimate the impact of members aged over 65.
Assuntos
Características da Família , Gastos em Saúde , Fatores Socioeconômicos , Humanos , Argentina , Gastos em Saúde/estatística & dados numéricos , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Adulto , Financiamento Pessoal/estatística & dados numéricos , Renda/estatística & dados numéricos , Doença Catastrófica/economiaRESUMO
OBJECTIVE: To identify the difference in breast cancer mortality rates among young women according to countries' economic classification. METHODS: A systematic literature review included retrospective studies on breast cancer mortality rates in women aged 20 to 49 years. Databases used were PubMed, Web of Science, Scopus, and Virtual Health Library, with articles selected in English, Portuguese, and Spanish. The study selection and analysis were conducted by two pairs of researchers. Data from 54 countries were extracted, including 39 high-income, 12 upper-middle-income, and 3 lower-middle-income countries. A meta-analysis was performed with the quantitative data from two studies. RESULTS: Six articles met the inclusion criteria. Four were analyzed descriptively due to data diversity, and two were included in the meta-analysis. The pooled mortality rate for high-income countries was 10.2 per 100,000 women (95% CI: 9.8-10.6), while for upper-middle-income countries, it was 15.5 per 100,000 women (95% CI: 14.9-16.1). Lower-middle-income countries had a pooled mortality rate of 20.3 per 100,000 women (95% CI: 19.5-21.1). The decrease in mortality rates in high-income countries was statistically significant (p<0.05). CONCLUSION: Mortality rates for breast cancer among young women have decreased significantly in high-income countries but have increased in lower-income countries. This disparity underscores the impact of insufficient investment in preventive measures, health promotion, early diagnosis, and treatment on young women's mortality in lower-income countries.