Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017.
Where this comes from
- Record sourced from PubMed, PMID 36779037.
- Also identified by DOI 10.1016/j.lana.2021.100042 and PMC identifier 9904117.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Income inequality can negatively affect population health by increasing social stress and conflict, and reducing trust, public goods and healthcare access. However there is limited evidence from low and middle-income countries (LMICs) with high levels of inequality. This study investigates the association between income inequality, morbimortality and risk factors of non-communicable diseases (NCDs) in 26 Brazilian states from 2002 to 2017. Data was acquired for men and women from the Global Health Data Exchange, the Brazilian Institute of Geography and Statistics, and the Brazilian Ministry of Health, totalling 416 state-year observations. Disability-adjusted life years (DALYs) and risk factors of NCDs were the dependent variables. Gini Index was the main independent variable. Multivariate linear panel regressions were performed, controlling for state and time fixed effects, gross domestic product per capita, population ageing, poverty and access to healthcare. A 1% increase in the Gini Index was associated with increases in alcohol abuse (of 923•4 DALYs per 100,000 people, 95%CI 217•6 to 1629•0) and diabetes mellitus morbidity (of 893•3 DALYs per 100,000 people, 95%CI 127•7 to 1659•0), and decreases in morbidity from attention disorder (of -4•0 DALYs per 100,000 people, 95%CI -7•4 to -0•5) and autism spectrum (of -2•4 DALYs per 100,000 people, 95%CI -4•3 to -0•5). These associations were greater for men, further supported by associations with alcohol use as a risk factor. This study provides evidence from a highly unequal LMIC, Brazil, of negative associations between income inequality and NCDs, and the importance of addressing wider social determinants of health. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001 as a Brazilian CAPES scholarship to AZD and by the São Paulo Research Foundation (FAPESP), grant 2020/15944-8 to RSG.