Income Inequality, Economic Growth and Stroke Mortality in Brazil: Longitudinal and Regional Analysis 2002-2009

Abstract

Background and PurposeStroke accounts for more than 10% of all deaths globally and most of it occurs in low- and middle-income countries (LMIC). Income inequality and gross domestic product (GDP) per capita has been associated to stroke mortality in developed countries. In LMIC, GDP per capita is considered to be a more relevant health determinant than income inequality. This study aims to investigate if income inequality is associated to stroke mortality in Brazil at large, but also on regional and state levels, and whether GDP per capita modulates the impact of this association.MethodsStroke mortality rates, Gini index and GDP per capita data were pooled for the 2002 to 2009 period from public available databases. Random effects models were fitted, controlling for GDP per capita and other covariates.ResultsIncome inequality was independently associated to stroke mortality rates, even after controlling for GDP per capita and other covariates. GDP per capita reduced only partially the impact of income inequality on stroke mortality. A decrease in 10 points in the Gini index was associated with 18% decrease in the stroke mortality rate in Brazil.ConclusionsIncome inequality was independently associated to stroke mortality in Brazil.

Doença cerebrovascular no Brasil de 1990 a 2015: Global Burden of Disease 2015

“…However, Vincens and Stafström estimated that social inequality would be an independent risk factor for cerebrovascular mortality, with an 18% reduction in mortality rates associated with the drop of 10 points on the Gini scale of social inequality 15 . In addition to the impact of both poverty and social inequality on the magnitude of cerebrovascular disease, this study corroborates more localized assessments, showing that the reduction in cerebrovascular mortality was unequal among states, being always more incisive in the federative units with better socioeconomic indicators.…”

“…The poorest regions, with the highest mortality rates, presented the greatest reductiondespite still remaining with the highest rates [9][10][11][12] . One of the main aspects of cerebrovascular mortality is that the reduction of the risk of death by the disease is much more unequal, according to social and economic indicators, in macro-regions, states or city districts than other chronic non-communicable diseases [14][15][16] . In the city of São Paulo, between 1996 and 2011, the decline in death rates due to stroke was much more significant in affluent districts compared to less affluent districts 16 .…”

Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016

“…Improvements in health outcomes from communicable diseases have been one notable result of the reforms, while the growing burden of non-communicable diseases (NCDs) presents a new challenge 5 . Industrialisation, urbanisation, economic growth, changes in income inequality, and the introduction of national and community health programmes are among the factors that have spurred declines in mortality and fertility in Brazil,1, 6, 7 and the subsequent expansion of the older population and decreasing population in the labour force demand new policies for health and social security 8, 9. High levels of violence, fuelled in part by the illegal drug trade, present another important health challenge 10, 11…”

Does working long hours increase the risk of cardiovascular disease for everyone?

“…However, to the best of our knowledge, no study has examined whether income level may affect the association between working hours and risk of CVD. Although the negative association between income and risk of CVD has been reported in previous research, income level of workers was considered only as a confounding factor in those earlier studies that examined the relationship between working hours and CVD.…”