ASSESSMENT OF THE IMPACT OF SOCIOECONOMIC DISPARITIES IN HEALTH AMONG RETIREMENT AGE ADULTS IN BRAZIL AND MEXICO
Flavia C. D. AndradeUniversity of Illinois at Urbana-Champaign, USA
Mariana López-OrtegaInstituto Nacional de Geriatría, Mexico
Background•Brazil and Mexico have the largest populations of older adults in Latin America. •2015: 16.5 million(8%) in Brazil and 8.2 million people (6.5%) in Mexico [1].
•Both countries also have experienced large gains in life expectancy in recent decades.
•Life expectancy at birth in 2010-2015: 74 in Brazil and 77.5 in Mexico.
Background•The increase in the proportion of older adults living longer has affected both public health care costs and pension systems in both countries.
•As a result, the issue of extending working life became an important policy issue given the population aging.
RetirementBRAZIL • Retirement age remains relatively low and no universal minimum age is
imposed [2]. • Average age at retirement on time at contribution was 54.4 for men and
51.3 for women – as a result, a man who retires receives his pension for an average 23.0 years and a woman for 29.2 years [3].
• About 7.2% of the Brazilian gross domestic product (GDP) is used to pay for retirement benefits.
MEXICO• In 2013, only 26.1% adults 60 years and over—35 per cent for men and
18.5 per cent for women [9]—had a retirement pension. • The public and private expenditure on pension benefits is approximately
1.8 percent of GDP [8].
Brazil
Mexico
Objective• Compare educational and sex differences in the health (i.e.
diabetes and hypertension) among adults 50-74. • We use estimates from nationally representative samples in Brazil
and Mexico to evaluate how the adoption of homogenous policies may differently influence social groups.
Data•Brazil
•Brazilian National Household Survey (PNAD) 2003 •National Health Survey (PNS) 2013.
•Mexico •Mexican National Health Survey (ENSA) 2000 •National Health and Nutrition Survey (ENSANUT) 2012
Methods•Descriptive statistics are provided by age, sex and period. •Logistic regressions•Locally-weighted scatterplot smoother (LOWESS)•Main variables: age, sex, educational levels, self-reported diabetes and hypertension
Education No education - no education or less than one year of formal schooling; Primary- one to six years of completed formal education More than primary - seven or more years of schooling
Brazil Mexico 2003 2013 2000 2012Health conditionsDiabetes 10.0 14.5 16.8 22.0Hypertension 40.8 42.0 30.8 31.1
EducationNo education 26.5 21.4 5.4 13.9Primary 48.0 45.8 69.3 49.3More than primary 25.5 32.8 25.3 36.8
SexMale 46.0 46.1 50.0 47.6Female 54.0 53.9 50.0 52.4
Age groups 50-54 30.2 28.6 32.5 31.2 55-59 23.6 26.0 24.0 26.2 60-64 19.2 19.4 19.8 18.0 65-69 15.1 14.9 13.8 13.4 70-74 12.0 11.1 9.9 11.1Sample size 57300 17320 8888 13020
Table 1. Descriptive statistics by year, Brazil and Mexico (weighted estimates)
Table 3. Estimates of logistic regressions on the association between self-reported diabetes, hypertension and socioeconomic status. Brazil and Mexico
Brazil MexicoVARIABLES OR ORDiabetes Education (ref=no education)Primary 1.07** 1.16***More than primary 0.86*** 1.04
Age 1.04*** 1.03***Female (ref=Male) 1.38*** 1.33***Most recent (ref=least recent) 1.50*** 1.37***Constant 0.01*** 0.03***Observations 73,443 21,778HypertensionEducation (ref=no education)Primary 1.03* 1.39***More than primary 0.79*** 1.40***
Age 1.04*** 1.04***Female (ref=Male) 1.76*** 2.02***Most recent (ref=least recent) 1.00 1.05Constant 0.04*** 0.02***Observations 74,378 20,995
Graph 1. Diabetes among Adult Women in Brazil (2013) and Mexico (2012)
Brazil
0.1
.2.3
.4D
iabe
tes
50 55 60 65 70 75Age in years
No education PrimaryMore than primary
Mexico
0.1
.2.3
.4
50 55 60 65 70 75age in years
No education PrimaryMore than primary
Graph 2. Diabetes among Adult Men in Brazil (2013) and Mexico (2012)
Brazil0
.1.2
.3.4
Dia
bete
s
50 55 60 65 70 75Age in years
No education PrimaryMore than primary
Mexico
0.1
.2.3
.4
50 55 60 65 70 75age in years
No education PrimaryMore than primary
Graph 3. Hypertension among Adult Women in Brazil (2013) and Mexico (2012)
Brazil
.1.2
.3.4
.5.6
Hyp
erte
nsio
n
50 55 60 65 70 75Age in years
No education PrimaryMore than primary
Mexico
.1.2
.3.4
.5.6
50 55 60 65 70 75age in years
No education PrimaryMore than primary
Graph 4. Hypertension among Adult Men in Brazil (2013) and Mexico (2012)
Brazil
.1.2
.3.4
.5.6
Hyp
erte
nsio
n
50 55 60 65 70 75Age in years
No education PrimaryMore than primary
Mexico
.1.2
.3.4
.5.6
50 55 60 65 70 75age in years
No education PrimaryMore than primary
Diabetes
0.2
.4.6
50 55 60 65 70 75Age in years
Hypertension
0.2
.4.6
50 55 60 65 70 75Age in years
No education Primary
More than primary
Poor health
0.2
.4.6
50 55 60 65 70 75Age in years
Graph 5. Health conditions among Adult Women in Brazil (2013)
Diabetes
0.1
.2.3
.4.5
50 55 60 65 70 75Age in years
Hypertension
0.1
.2.3
.4.5
50 55 60 65 70 75Age in years
Poor health
0.1
.2.3
.4.5
50 55 60 65 70 75Age in years
No education PrimaryMore than primary
Graph 6. Health conditions among Adult Men in Brazil (2013)
0.2
.4.6
.8 Diabetes
50 55 60 65 70 75
0.2
.4.6
.8
Hypertension
50 55 60 65 70 75
0.2
.4.6
.8
Poor health
50 55 60 65 70 75
No educPrimaryMore than primary
0.2
.4.6
.8
ADL
50 55 60 65 70 75
Graph 8. Health conditions among Adult Women in Mexico, MHAS (2015)
0.1
.2.3
.4.5
Diabetes
50 55 60 65 70 75
0.1
.2.3
.4.5 Hypertension
50 55 60 65 70 75
0.1
.2.3
.4.5
Poor health
50 55 60 65 70 75
No educPrimary
More than primary
0.1
.2.3
.4.5
ADL
50 55 60 65 70 75
Graph 8. Health conditions among Adult Men in Mexico, MHAS (2015)
Discussion• For Mexico the possible mediating effect of SES on access to health services and
detection of chronic diseases should be explored in the future as there are important differences in prevalence by self-report vs. measurements, for example in hypertension self-report vs. blood pressure measured at the time of the survey.
Percentage of adults with hypertension, by sex and age group. ENSANUT 2012
Source: Gutierrez et al., 2013
50-59 60-69 70-79 80+
22.333.5 31
39.3
21.8
25.8 28.821.2
MenSelf-reported % Detected %
50-59 60-69 70-79 80+
29.4
47.1 43.135.8
18
14.8 22.7
15.8
WomenSelf-reported % Detected %
Graph 9. Self-reported and Measured Hypertension among Adult Women in Mexico, ENSANUT (2012)
Self-reported
.2.3
.4.5
.6
50 55 60 65 70 75age in years
No education PrimaryMore than primary
Measured
.2.3
.4.5
.6
50 55 60 65 70 75age in number of years
Graph 10. Self-reported and Measured Hypertension among Adult Men in Mexico, ENSANUT (2012)
Self-reported
.1.2
.3.4
.5
50 55 60 65 70 75
No education PrimaryMore than primary
Measured
.1.2
.3.4
.5
50 55 60 65 70 75
Discussion•Important social gradients •Women with more education were less likely to report having diabetes in Brazil and Mexico
•However, among men self-reported diabetes was more reported among those with more education (even though for more recent cohorts, the situation seems to be changing)
Discussion• In Brazil, women with more education reported lower prevalence of
hypertension than those with less education, but the reverse was found in Mexico based on self-reported data. When analyzing blood pressure measurements, similar levels were found among women with no education and more than primary.
• Among men, those with less education reported lower prevalence of hypertension. In contrast, less educated men have higher prevalence of hypertension when using measured blood pressure.
Limitations• Self-reported data that implies individuals have had access to
health care services, while such access can also have important SES gradients.
• Focus only on diabetes and hypertension• Need to incorporate other health conditions (e.g. disability, mobility,
SHR)• Urban/rural differences• Occupational differences
Thanks
WordingBrazil• 2003“...have [health
condition]?”• “Has a doctor has given you a
diagnosis of [health condition]?
Mexico•2000 and 2012: “Has a physician told you have (health condition)”?
(Rocha and Caetano 2008)
(Rofman, Lucchetti et al.)
(Rofman, Lucchetti et al.)
(Rofman, Lucchetti et al.)
Beltran-Sanchez & Andrade (forthcoming)
Beltran-Sanchez & Andrade (forthcoming)
Brazil Mexico Mexico MHASVARIABLES OR se OR se OR seDiabetes Education (ref=no education) .Primary 1.07** 0.03 1.16*** 0.06 1.10 0.07More than primary 0.86*** 0.03 1.04 0.06 0.88 0.06
Age 1.04*** 0.00 1.03*** 0.00 1.02*** 0.00Female (ref=Male) 1.38*** 0.03 1.33*** 0.05 1.37*** 0.06Year 2013 (ref=2003) 1.50*** 0.04 1.37*** 0.05Constant 0.01*** 0.00 0.03*** 0.01 0.06*** 0.02Observations 73,443 21,778 10491 HypertensionEducation (ref=no education)Primary 1.03* 0.02 1.39*** 0.07 1.14** 0.07More than primary 0.79*** 0.02 1.40*** 0.08 1.01 0.07
Age 1.04*** 0.00 1.04*** 0.00 1.05*** 0.00Female (ref=Male) 1.76*** 0.03 2.02*** 0.06 1.79*** 0.07Most recent year (ref=least recent) 1.00 0.02 1.05 0.03Constant 0.04*** 0.00 0.02*** 0.00 0.02*** 0.01Observations 74,378 20,995 10493