Income inequality and mortality: results from a longitudinal study of older residents of São Paulo, Brazil.

ABSTRACT

OBJECTIVES: We determined whether community-level income inequality was associated with mortality among a cohort of older adults in São Paulo, Brazil. METHODS: We analyzed the Health, Well-Being, and Aging (SABE) survey, a sample of community-dwelling older adults in São Paulo (2000-2007). We used survival analysis to examine the relationship between income inequality and risk for mortality among older individuals living in 49 districts of São Paulo. RESULTS: Compared with individuals living in the most equal districts (lowest Gini quintile), rates of mortality were higher for those living in the second (adjusted hazard ratio [AHR] = 1.44, 95% confidence interval [CI] = 0.87, 2.41), third (AHR = 1.96, 95% CI = 1.20, 3.20), fourth (AHR = 1.34, 95% CI = 0.81, 2.20), and fifth quintile (AHR = 1.74, 95% CI = 1.10, 2.74). When we imputed missing data and used poststratification weights, the adjusted hazard ratios for quintiles 2 through 5 were 1.72 (95% CI = 1.13, 2.63), 1.41 (95% CI = 0.99, 2.05), 1.13 (95% = 0.75, 1.70) and 1.30 (95% CI = 0.90, 1.89), respectively. CONCLUSIONS: We did not find a dose-response relationship between area-level income inequality and mortality. Our findings could be consistent with either a threshold association of income inequality and mortality or little overall association.