Health inequalities in cause-specific mortality in Costa Rica: a population-based cohort study
DOI:
https://doi.org/10.11606/s1518-8787.2023057004331Palavras-chave:
Cause of Death, Health Status Disparities, Socioeconomic Factors, Developing Countries, Ecological StudiesResumo
OBJECTIVE: To analyze health inequalities in cause-specific mortality in Costa Rica from 2010 to 2018, observing the main causes for inequality in the country. METHODS: The National Electoral Rolls were used to follow-up all Costa Rican adults aged 20 years or older from 2010 to 2018 (n = 2,739,733) in an ecological study. A parametric survival model based on the Gompertz distribution was performed and the event death was classified according to the ICD-10. RESULTS: After adjustment for urbanicity, the poorest districts had a higher mortality than the wealthier districts for most causes of death except neoplasms, mental and behavioral disorders, and diseases of the nervous system. Urban districts showed significantly higher mortality than mixed and rural districts after adjustment for wealth for most causes except mental and behavioral disorders, diseases of the nervous system, and diseases of the respiratory system. Differences according to wealth were more frequent in women than men, whereas differences according to urbanicity were more frequent in men than in women. CONCLUSIONS: The study’s findings were consistent, but not fully similar, to the international literature.
Referências
Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661-9. https://doi.org/10.1016/S0140-6736(08)61690-6
Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-104. https://doi.org/10.1016/S0140-6736(05)71146-6
Stringhini S, Carmeli C, Jokela M, Avendaño M, Muennig P, Guida F, et al. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet. 2017;389(10075):1229-37. https://doi.org/10.1016/S0140-6736(16)32380-7
Mackenbach JP, Valverde JR, Artnik B, Bopp M, Brønnum-Hansen H, Deboosere P, et al. Trends in health inequalities in 27 European countries. Proc Natl Acad Sci U S A. 2018;115(25):6440-5. https://doi.org/10.1073/pnas.1800028115
Pappas G, Queen S, Hadden W, Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993;329(2):103-9. https://doi.org/10.1056/NEJM199307083290207
Mackenbach JP, Kulhánová I, Menvielle G, Bopp M, Borrell C, Costa G, et al. Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. J Epidemiol Community Health. 2015;69(3):207-17. https://doi.org/10.1136/jech-2014-20431
Smith GD, Neaton JD, Wentworth D, Stamler R, Stamler J. Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. White men. Am J Public Health. 1996;86(4):486-96. https://doi.org/10.2105/ajph.86.4.486
Huisman M, Kunst AE, Andersen O, Bopp M, Borgan JK, Borrell C, et al. Socioeconomic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Community Health. 2004;58(6):468-75. https://doi.org/10.1136/jech.2003.010496
Cohen S. Social status and susceptibility to respiratory infections. Ann N Y Acad Sci. 1999;896:246-53. https://doi.org/10.1111/j.1749-6632.1999.tb08119.x
Erikson R, Torssander J. Social class and cause of death. Eur J Public Health. 2008;18(5):473-8. https://doi.org/10.1093/eurpub/ckn053
Mackenbach JP. Health inequalities: Europe in profile. Rotterdam (NL): Erasmus MC; 2006 [cited 2019 Jun 3].]. Available from: https://ec.europa.eu/health/ph_determinants/socio_economics/documents/ev_060302_rd06_en.pdf
Demakakos P, Biddulph JP, Bobak M, Marmot MG. Wealth and mortality at older ages: a prospective cohort study. J Epidemiol Community Health. 2016;70(4):346-53. https://doi.org/10.1136/jech-2015-206173
Rosero-Bixby L, Dow WH. Exploring why Costa Rica outperforms the United States in life expectancy: a tale of two inequality gradients. Proc Natl Acad Sci U S A. 2016;113(5):1130-7. https://doi.org/10.1073/pnas.1521917112
Petrovic D, Mestral C, Bochud M, Bartley M, Kivimäki M, Vineis P, et al. The contribution of health behaviors to socioeconomic inequalities in health: a systematic review. Prev Med. 2018;113:15-31. https://doi.org/10.1016/j.ypmed.2018.05.003
Hoffmann R, Borsboom G, Saez M, Dell’Olmo MM, Burström B, Corman D, et al. Social differences in avoidable mortality between small areas of 15 European cities: an ecological study. Int J Health Geogr. 2014;13:8. https://doi.org/10.1186/1476-072X-13-8
Mackenbach JP, Rubio Valverde J, Bopp M, Brønnum-Hansen H, Costa G, Deboosere P, et al. Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015. Eur J Epidemiol. 2019;34(12):1131-42. https://doi.org/10.1007/s10654-019-00580-9
Mackenbach JP, Stirbu I, Roskam AJR, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468-81. https://doi.org/10.1056/NEJMsa0707519
Dobson A, McLaughlin D, Vagenas D, Wong KY. Why are death rates higher in rural areas? Evidence from the Australian Longitudinal Study on Women’s Health. Aust N Z J Public Health. 2010;34(6):624-8. https://doi.org/10.1111/j.1753-6405.2010.00623.x
Bilal U, Alazraqui M, Caiaffa WT, Lopez-Olmedo N, Martinez-Folgar K, Miranda JJ, et al. Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis. Lancet Planet Health. 2019;3(12):e503-10. https://doi.org/10.1016/S2542-5196(19)30235-9
Ferri CP, Acosta D, Guerra M, Huang Y, Llibre-Rodriguez JJ, Salas A, et al. Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study. PLOS Med. 2012;9(2):e1001179. https://doi.org/10.1371/journal.pmed.1001179
Chiavegatto Filho ADP, Gotlieb SLD, Kawachi I. Cause-specific mortality and income inequality in São Paulo, Brazil. Rev Saude Publica. 2012;46(4):712-8. https://doi.org/10.1590/S0034-89102012005000039
Fantin R, Gómez-Duarte I, Sáenz-Bonilla JP, Rojas-Araya K, Barboza-Solís C. Measuring socioeconomic position from the social inequalities in health perspective?: the case of Costa Rica. Odovtos Int J Dent Sci. 2019;21(3)65-75. https://doi.org/10.15517/IJDS.2019.37295
Wilkinson R, Pickett K. The spirit level: why more equal societies almost always do better. London (UK): Allen Lane; 2009. 352 p.
Barboza Solís C, Saenz-Bonilla JP, Fantin R, Gómez Duarte I, Rojas Arraya K. [Theoretical implications for the analysis of social health inequalities: a discussion]. Odovtos Int J Dent Sci. 2020;22(1):11-21. Spanish. https://doi.org/10.15517/ijds.2020.39097
World Bank Group. Poverty and shared prosperity: taking on inequality. Washington, DC; 2016.
World Bank Group. Life expectancy at birth, total (years). Washington, DC; 2018 [cited 2019 Jun 3]. Available from: https://data.worldbank.org/indicator/SP.DYN.LE00.IN
Pérez Brignoli H, López Ruiz LA. Evaluación de cobertura: estadísticas de nacimiento y defunción – Costa Rica 2000-2012. San José (CR): Instituto Nacional de Estadística y Censos; 2017 [cited 2019 Jun 3]. Available from: http://www.inec.go.cr/sites/default/files/documetos-biblioteca-virtual/anevalnacdefun2000-2012.pdf
Fantin R, Santamaría-Ulloa C, Barboza Solís C. Socioeconomic inequalities in cancer mortality: is Costa Rica an exception to the rule? Int J Cancer. 2020;147(5):1286-93. https://doi.org/10.1002/ijc.32883
Fantin R, Santamaría-Ulloa C, Barboza-Solís C. Social gradient in cancer incidence in Costa Rica: findings from a national population-based cancer registry. Cancer Epidemiol. 2020;68:101789. https://doi.org/10.1016/j.canep.2020.101789
Rosero Bixby L. High life expectancy and reversed socioeconomic gradients of elderly people in Mexico and Costa Rica. Demogr Res. 2018;38(3):95-108. https://doi.org/10.4054/DemRes.2018.38.3
Rosero-Bixby L, Dow WH. Surprising SES Gradients in mortality, health, and biomarkers in a Latin American population of adults. J Gerontol B Psychol Sci Soc Sci. 2009;64(1):105-17. https://doi.org/10.1093/geronb/gbn004
Fantin R, Barboza Solís C. Las inequidades de esperanza de vida según la provincia de nacimiento en Costa Rica entre 2013 y 2017. Poblac Salud Mesoam. 2020;18(1). https://doi.org/10.15517/psm.v18i1.39073
Fantin R, Delpierre C, Kelly-Irving M, Barboza-Solís C. Complex social gradient in life expectancy in Costa Rica: an ecological study with 24-million person-years follow-up. Odovtos Int J Dent Sci .2021;23(3):155-67. https://doi.org/10.15517/ijds.2021.46128
Barboza Solís C, Reyes-Carmona J, Fantin R. Social inequality in incidence and mortality of malignant neoplasms of lip, oral cavity and pharynx: is Costa Rica an international paradox? Community Dent Oral Epidemiol. 2021 Jun 2. https://doi.org/10.1111/cdoe.12658. Epub ahead of print.
Tribunal Supremo de Elecciones (CR). Estadísticas de sufragio febrero de 2016. San José (CR); 2017 [citado 2019 Jun 3]. Available from: http://www.tse.go.cr/pdf/elecciones/estadisticassufragio_febrero2016.pdf
Méndez Fonseca F, Trejos Solórzano JD. Costa Rica : un mapa de carencias críticas para el año 2000. San José (CR); Centro Centroamericano de Población; 2004 [cited 2019 Jun 3]. Available from: http://biblioteca.ccp.ucr.ac.cr/handle/123456789/1219
Espinoza Aguirre A, Fantin R, Barboza Solis C, Salinas Miranda A. Características sociodemográficas asociadas a la prevalencia del consumo de tabaco en Costa Rica. Rev Panam Salud Publica. 2020;44:e17. https://doi.org/10.26633/RPSP.2020.17
Organización Mundial de la Salud. Estadísticas sanitarias mundiales 2020: monitoreando la salud para los ODS, objetivo de desarrollo sostenible. Geneva (CH): WHO; 2020 [cited 2021 Mar 03]. Available from: https://apps.who.int/iris/handle/10665/338072
Universidad de Costa Rica, Escuela de Estadística, Unidad de Servivios Estadísticos. Estudio sobre patrones de consumo de bebidas alcohólicas en Costa Rica. San José (CR): Educalcohol Costa Rica; 2013 [cited 2019 Jun 3]. Available from: http://educalcoholcr.org/files/program/33_patronesdeconsumodebebidasalcoholicasencostaricaeducalcoholucr.pdf
UNICEF Costa Rica. Encuesta de Mujeres, Niñez y Adolescencia (EMNA) 2018. San José (CR); 2019 [cited 2019 Jun 3]. Available from: https://www.unicef.org/costarica/informes/encuesta-de-mujeres-ninez-y-adolescencia-2018
Ministerio de Salud (CR). Encuesta Nacional de Nutrición 2008-2009. San José (CR); 2013.
Gamboa-Gamboa T, Fantin R, Cordoba J, Caravaca I, Gómez-Duarte I. Relationship between childhood obesity and socioeconomic status among primary school children in Costa Rica. Public Health Nutr. 2021;24(12):3825-33. https://doi.org/10.1017/S1368980021002032
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2023 Romain Fantin, Cyrille Delpierre, Cristina Barboza-Solís
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
