Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review

Abstract

OBJECTIVE Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. METHODS This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations. RESULTS Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation. CONCLUSIONS Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.

Changes in childhood stroke mortality from 1990 to 2019 in Brazil and its federative units

“…Other study on leading causes of death in Brazil observed that between 2000 and 2012 the mortality rates due to cerebrovascular diseases, hypertensive diseases and circulatory system diseases were influenced by socioeconomic factors. There was a significant inverse association between socioeconomic factors and mortality rates 32 . In view of this, it is possible that improvement in socioeconomic conditions of these localities, as evidenced by increasing sociodemographic indices 33 over the period, influenced the high percentage reduction in childhood stroke mortality; however, at the same time, inefficient or inadequate data recording may have favored underreported deaths.…”

Mortalidade por doenças infecciosas e parasitárias no Nordeste do Brasil de 2000 a 2019: estudo ecológico de série temporal

“…Na região Nordeste existe um grande grau de desigualdade, presente no âmbito econômico e em serviços públicos como na educação e moradia. Assim, resultando em fatores gerais que facilitam a ocorrência de DIPs como o contraste social, baixa renda e baixa escolaridade, os quais influenciam na qualidade de vida e no acesso ao sistema de saúde, prejudicando assim, o tratamento e favorecendo o ciclo de autoinfecção (ICHIHARA MY, et al, 2022). Vale ressaltar que, também existem fatores condicionantes ao maior número de óbitos por DIPs entre indivíduos de determinado sexo.…”

Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil

“…In Brazil, between 1982 and 2015, IMR decreased more than 80% (from 71.3:1000 LB to 14.0:1000 LB), placing the country among those that successfully met objective number four of the Millennium Development Goals, whose target was a two-thirds reduction in the mortality of infants under 5 years old, between 1990 and 2015 [ 2 , 3 ]. The sharp decline in infant mortality in Brazil in the period was due to the expansion of access to prenatal care and hospital care for childbirth in the SUS (acronym in Portuguese for Unified Health System - Sistema Unico de Saúde), promotion of breastfeeding, increased vaccination coverage, monitoring of the child’s growth and development in the first year of life, and reduction in geographical and economic inequalities in the country, which still persist nonetheless [ 4 – 6 ]. In 2017, the IMR in Brazil was 13.4:1000 LB, with the South (where the Rio Grande do Sul state is located) and Southeast regions of the country showing rates below the national average (10.1 and 11.3:1000 LB, respectively), while in the North (15.4:1000 LB), Northeast (14.1:1000 LB), and Central-West region (11.7:1000 LB) the means were higher [ 7 ].…”

“…[8][9][10][11].3) 7.5 (6.0-9.2) 5.0 (3.8-6.4) 4.0 (3.0-5.3) 1 6. (1.0-2.5) 1.3 (0.7-2.1) 2.9 (2.0-4.0) 2.3 (1.5-3.3) 7.7 (6.7-8.8) 5.3 (4.5-6.2) 4.1 (3.4-4.9) 2.0 (1.5-2.6) 1.4 (1.0-1.9) 3.0 (2.4-3.7) 2.2 (1.7-2.8) 3rd 36,977 9.6 (8.6-10.6) 7.4 (6.6-8.3) 5.1 (4.4-5.9) 4.1 (3.5-4.8) 1.6 (1.2-2.0) 1.3 (1.0-1.7) 2.9 (2.4-3.5) 2.0 (1.6-2.5) 8.4 (7.7-9.1) 4.9 (4.4-5.5) 4.2 (3.7-4.7) 2.2 (1.8-2.6) 1.7 (1.4-2.0) 3.2 (2.8-3.7) 2.5 (2.1-2.9) 9.9 (8.7-11.2) 8.5 (7.4-9.7) 3.9 (3.1-4.7) 3.3 (2.6-4.1) 4.9 (4.1-5.9) 4.1 (3.3-5.0) ≥ 7 108,239 5.1 (4.7-5.5) 3.4 (3.1-3.8) 2.1 (1.8-2.4) 1.5 (1.3-1.7) 1.0 (0.8-1.2) 0.6 (0.5-0.8) 1.9 (1.6-2.2) 1.3 (1.1-1.5) Type of delivery (N = 141,530) 9.4 (8.8-10.0) 6.2 (5.7-6.7) 5.6 (5.2-6.1) 1.7 (1.5-2.0) 1.4 (1.2-1.6) 3.1 (2.8-3.4) 2.5 (2.2-2.8)…”