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      Desigualdade social e saúde entre idosos brasileiros: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios Translated title: Socioeconomic circumstances and health among the brazilian elderly: a study using data from a National Household Survey

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          Abstract

          A influência da situação sócio-econômica sobre a saúde dos idosos é controversa. Nós utilizamos dados da PNAD 1998 para examinar esta influência em uma amostra de 19.068 idosos representativos da população brasileira com <FONT FACE=Symbol>³</FONT> 65 anos de idade. Aqueles com renda domiciliar per capita situada no quintil mais baixo foram comparados àqueles com renda mais alta (< 0,67 e <FONT FACE=Symbol>³</FONT> 0,67 salários mínimos). Os idosos com renda mais baixa apresentaram piores condições de saúde (pior percepção da saúde, interrupção de atividades por problemas de saúde, ter estado acamado e relato de algumas doenças crônicas), pior função física (avaliada através de seis indicadores) e menor uso de serviços de saúde (menor procura e menos visitas a médicos e dentistas). Esses resultados não confirmam observações realizadas em alguns países desenvolvidos quanto à ausência de associação entre o nível sócio-econômico e a saúde do idoso. Ao contrário, os resultados deste trabalho mostram que mesmo pequenas diferenças na renda domiciliar são suficientemente sensíveis para identificar idosos com piores condições de saúde e menor acesso aos serviços de saúde no Brasil.

          Translated abstract

          The influence of socioeconomic circumstances on senior citizens' health is still controversial. We used data from the 1998 Brazilian National Household Survey (PNAD 1998) to examine this influence. A representative sample of the Brazilian population aged <FONT FACE=Symbol>³</FONT> 65 years (n = 19,068) were included in the study. The characteristics of those in the lower quintile of per capita household income were compared with those with higher income (< 0.67 vs<FONT FACE=Symbol>³</FONT> 0.67 the Brazilian minimum wage). The lower income group presented worse health conditions (self-rated health, inability to perform routine activities due to a health problem, bedridden conditions, and a report of any disease), and worse physical functioning (level of difficulty in performing selected physical activities), and less frequent use of medical and dental services. These results do not confirm observations, in some developed countries, of a lack of association between socioeconomic status and health among the elderly. On the contrary, according to our results, in Brazil even small differences in income are sufficiently sensitive to identify older adults with worse health conditions and limited access to health services.

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          Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning.

          Although the relation between low income and poor health is well established, most previous research has measured income at only one time. We used income information collected in 1965, 1974, and 1983 from a representative sample of adults in Alameda County, California, to examine the cumulative effect of economic hardship (defined as a total household income of less than 200 percent of the federal poverty level) on participants who were alive in 1994. Because of missing information, analyses were based on between 1081 and 1124 participants (median age, 65 years in 1994). After adjustment for age and sex, there were significant graded associations between the number of times income was less than 200 percent of the poverty level (range, 0 to 3) and all measures of functioning examined except social isolation. As compared with subjects without economic hardship, those with economic hardship in 1965, 1974, and 1983 were much more likely to have difficulties with independent activities of daily living (such as cooking, shopping, and managing money) (odds ratio, 3.38; 95 percent confidence interval, 1.49 to 7.64), activities of daily living (such as walking, eating, dressing, and using the toilet) (odds ratio, 3.79; 95 percent confidence interval, 1.32 to 9.81), and clinical depression (odds ratio, 3.24; 95 percent confidence interval, 1.32 to 7.89) in 1994. We found little evidence of reverse causation -- that is, that episodes of illness might have caused subsequent economic hardship. Sustained economic hardship leads to poorer physical, psychological, and cognitive functioning.
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            Social support and social structure: a descriptive epidemiology.

            Despite a very large and growing literature demonstrating the significance of social support for health and well-being, surprisingly little is known about the social distribution of this crucial resource. This paper presents data on the distribution of social support and support resources across social class, marital status, age and gender, with the aims of contributing toward an understanding of the impact of social structures on processes of social support, and of assessing the hypothesis that epidemiological variations in mental health arise partially from social support differences. The epidemiology of perceived social support was found to correspond closely to the epidemiology of psychological distress and disorder. The single exception involved gender, where a positive rather than negative relationship was observed, with women demonstrating the highest levels of both social support and psychological distress. The observed patterns of variation in social support link this significant adaptive resource to one's locations in the social structure and reinforce the conclusion that it represents a promising intervention target. The practical importance of these results, however, are not matched by theoretical significance. Except in the case of marital status, our findings largely discount the hypothesis that the social distribution of mental health is partially attributable to social support differences.
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              Education, age, and the cumulative advantage in health.

              The positive association between educational attainment and health is well established, but the way in which the education-based gap in health varies with age is not. Do the health advantages of high educational attainment and disadvantages of low educational attainment diverge or converge with age? The cumulative advantage perspective predicts a diverging SES gap in health with age, but past evidence does not allow us to accept or reject the hypothesis. We address this issue in two samples, cross-sectionally and over time, with three health measures. The first data set consists of a 1990 telephone interview of a national probability sample of U.S. households. There are 2,031 respondents, aged 18 to 90. The second is a national probability sample of U.S. households in which 2,436 respondents aged 20 to 64 were interviewed by telephone in 1979 and reinterviewed in 1980. We find that the gap in self-reported health, in physical functioning, and in physical well-being among people with high and low educational attainment increases with age. The health advantage of the well educated is larger in older age groups than in younger. Health advantages of high income and disadvantages of low income also diverge with age, but household income does not explain education's positive effect.
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                Author and article information

                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                0102-311X
                1678-4464
                June 2003
                : 19
                : 3
                : 745-757
                Affiliations
                [01] Belo Horizonte Minas Gerais orgnameUniversidade Federal de Minas Gerais orgdiv1Fundação Oswaldo Cruz orgdiv2Centro de Pesquisas René Rachou Brazil
                Article
                S0102-311X2003000300007 S0102-311X(03)01900307
                10.1590/S0102-311X2003000300007
                bf440fbf-39f7-43fd-becc-7cd63a437b61

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 18 April 2002
                : 09 October 2002
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 13
                Product

                SciELO Public Health

                Self URI: Texto completo somente em PDF (PT)
                Categories
                Artigos

                Social Conditions,Condições Sociais,Aging Health,Saúde do Idoso,Aging,Envelhecimento

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