Inequalities in healthy life expectancy by Federated States

Abstract

OBJECTIVES To estimate the healthy life expectancy at 60 years by sex and Federated States and to investigate geographical inequalities by socioeconomic status.METHODS Healthy life expectancy was estimated by the Sullivan method, based on the information of the National Survey on Health, 2013. Three criteria were adopted for the definition of “unhealthy state”: self-assessment of bad health, functionality for performing the activities of daily living, and the presence of noncommunicable disease with intense degree of limitation. The indicator of socioeconomic status was built based on the number of goods at household and educational level of the head of household. To analyze the geographical inequalities and socioeconomic level, inequality measures were calculated, such as the ratio, the difference, and the angular coefficient.RESULTS Healthy life expectancy among men ranged from 13.8 (Alagoas) to 20.9 (Espírito Santo) for the self-assessment criterion of bad health. Among women, the corresponding estimates were always higher and ranged from 14.9 (Maranhão) to 22.2 (São Paulo). As to the ratio of inequality by Federated State, the medians were always higher for healthy life expectancy than for life expectancy, regardless of the definition adopted for healthy state. Regarding the differences per Federated State, the healthy life expectancy was seven years higher in one state than in another. By socioeconomic status, differences of three and four years were found, approximately, between the last and first fifth, for men and women, respectively.CONCLUSIONS Despite the association of the mortality indicators with living conditions, the inequalities are even more pronounced when the welfare and the limitations in usual activities are considered, showing the necessity to promote actions and programs to reduce the socio-spatial gradient.

A comparative, correlate analysis and projection of global and regional life expectancy, healthy life expectancy, and their GAP: 1995-2025

“…The health care needs of people suffering from chronic diseases have increased [ 26 ]. Insufficient investment in health care costs and unreasonable utilization of the infrastructure remain important challenges to improving the health of the worldwide population in the future [ 5 , 15 ].…”

“…LE is the most commonly used indicator to assess population health [ 4 ], and socioeconomic development and health care services are important factors affecting LE [ 5 ]. However, LE cannot fully reflect the quality of life.…”

Access to medicines:

“…We adopted an operational concept of a study of PNAUM 27 , in which the institutionalization of PS is defined as a social and political-administrative process. This process is expressed in the creation and implementation of formal structures in the health system, in the organization of services, in structure and mechanisms of financing, management tools, involvement in social participation and control, and conduction of practices and activities inherent to PS as a component of comprehensive health care.…”

Actividad física, salud y funcionalidad entre adultos mayores según la localidad geográfica

“…La evaluación de diferentes niveles de limitaciones funcionales es fundamental para entender mejor las diferencias entre las necesidades y demandas de los adultos mayores, pues los niveles de dependencia están asociados a una mayor demanda por cuidados a largo plazo y mortalidad 5 . Por otro lado, estudios sugieren que el análisis de diferentes regiones, aspectos socioeconómicos y demográficos son de gran importancia para la planificación y el delineamiento de políticas públicas orientadas al bienestar de la población adulta mayor 6,7 . Sin embargo, es necesaria más evidencia para conocer las diferencias asociadas a la salud y la funcionalidad que pueden existir dependiendo de la localidad donde un adulto mayor vive.…”