Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE)

Silva, Alexandre da; Rosa, Tereza Etsuko da Costa; Batista, Luís Eduardo; Kalckmann, Suzana; Louvison, Marília Cristina Prado; Teixeira, Doralice Severo da Cruz; Lebrão, Maria Lúcia

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 21 (Suppl 02) • 2018 • https://doi.org/10.1590/1980-549720180004.supl.2 copy

Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Introduction:

Understanding racial disparities in Brazil has been very complex and poorly investigated in some population segments, such as the elderly individuals.

Objective:

This study aimed to present descriptively a comparative analysis in a racial perspective of sociodemographic profile, health conditions, and health service use by older people in the city of São Paulo.

Methods:

This is a cross-sectional analysis of the Health, Welfare and Aging Study (SABE). For this study, 1,345 elderly individuals were considered in the cohort of 2010. Data about the black, brown, and white elders were selected. The data were addressed in three major axes: sociodemographic, health conditions, and health service use. The chosen epidemiological measure of association was the prevalence ratio (PR), as well as the percentage values for expressing differences among the groups.

Results and conclusion:

The results showed a more favorable scenario for the aging of the white elderly compared to those of brown or black color, considering sociodemographic indicators, health conditions or use and access to health services.

Keywords:
Social inequity; Health inequalities; Ethnicity and health; Color; Aging; Racism

Variables	Frequency (%)			Total	Prevalence Ratio			p-value
Variables	Black	Brown	White	Total	Black	Brown	White	p-value
Sex (1,263)
Male	46.60	39.00	39.20	39.70	1.17	0.98	0.99	0.400
Female	53.40	61.00	60.80	60.30	0.89	1.01	1.01	0.400
Age (1,263) (years)
60 to 64	26.70	42.30	28.20	32.40	0.82	1.31	0.87	< 0.001
65 to 69	24.80	27.00	19.10	22.00	1.13	1.23	0.87
70 to 74	16.60	13.60	20.00	17.80	0.93	0.76	1.12
75 to 79	15.30	6.60	15.40	12.70	1.20	0.52	1.21
80 and older	16.60	10.40	17.20	15.10	1.10	0.69	1.14
Marital status (1,247)
Divorced/widower	43.20	40.70	42.10	41.70	1.04	0.98	1.01	0.050
Married	47.90	55.60	55.30	54.90	0.87	1.01	1.01
Single	9.00	3.70	2.70	3.40	2.65	1.09	0.79
Number of living children (1,242)
None	10.70	3.30	4.20	4.40	2.43	0.75	0.95	< 0.001
1 or 2	29.20	29.30	40.80	36.40	0.80	0.80	1.12
3 or more	60.10	67.40	55.00	59.20	1.01	1.14	0.93
Sufficient income for daily expenses (1,233)
Yes	49.70	48.90	61.40	56.70	0.88	0.86	1.08	< 0.001
No	50.30	51.10	38.60	43.30	1.16	1.18	0.89	< 0.001
Reads and writes messages (1,259)
Yes	76.80	81.10	90.70	86.80	0.88	0.93	1.04	< 0.001
No	23.20	18.90	9.30	13.20	1.76	1.43	0.70	< 0.001
Schooling in years (mean; 95%CI) (1,245)	3.90 (3.01; 4.79)	4.09 (3.52; 4.66)	6.10 (5.49; 6.72)	5.31 (4.77; 5.85)

Variables	Frequency (%)			Total	Prevalence Ratio			p-value
Variables	Black	Brown	White	Total	Black	Brown	White	p-value
Lives alone (1,263)
Yes	18.90	15.40	15.30	15.60	1.21	0.99	0.98	0.720
Religion (1,256)
Catholic	61.60	59.80	64.80	63.00	0.98	0.95	1.03	0.001
Evangelical	32.90	29.90	20.40	24.20	1.36	1.24	0.84
Other or none	5.50	10.30	14.80	12.80	0.43	0.80	1.16
Leaves the house (867)
Frequently	6.00	12.10	17.60	15.30	0.39	0.79	1.15	0.005
Sometimes/rarely	29.30	38.10	41.50	39.80	0.74	0.96	1.04
Never	64.80	49.80	40.90	44.90	1.44	1.11	0.91
Invites people over (868)
Frequently	30.20	41.30	40.10	39.70	0.76	1.04	1.01	0.018
Sometimes/rarely	27.70	35.90	38.90	37.30	0.74	0.96	1.04
Never	42.10	22.70	21.00	23.00	1.83	0.99	0.91
Works (1,256)
Yes	38.60	38.30	29.50	32.80	1.18	1.17	0.90	0.010
No	61.40	61.70	70.50	67.20	0.91	0.92	1.05	0.010
Reasons to work (344)
Financial needs	65.50	72.50	67.70	69.30	0.95	1.05	0.98	0.630
Keeping busy	34.50	27.50	32.30	30.70	1.12	0.90	1.05	0.630
Lived in the countryside for five years or more (341)
Yes	44.30	59.30	41.50	49.00	0.90	1.21	0.85	0.020
No	55.70	40.70	58.50	51.00	1.09	0.80	1.15	0.020

Variables	Frequency (%)			Total	Prevalence Ratio			p-value
Variables	Black	Brown	White	Total	Black	Brown	White	p-value
Self-report of health (1,224)
Very good/good	41.80	48.30	52.30	50.30	0.83	0.96	1.04	0.380
Fair	48.10	43.60	40.20	41.80	1.15	1.04	0.96
Bad/very bad	10.00	8.10	7.50	7.90	1.27	1.03	0.95
Osteoporosis (1,252)
Yes	14.20	16.20	21.00	19.10	0.74	0.85	1.10	0.053
Arterial hypertension (1,262)
Yes	83.00	67.30	64.40	66.60	1.25	1.01	0.97	0.003
Diabetes (1,262)
Yes	40.80	22.80	23.80	24.60	1.66	0.93	0.97	0.005
Stroke (1,260)
Yes	18.70	7.20	6.10	7.30	2.56	0.99	0.84	< 0.001
Self-assessment of memory (1.232)
Excellent/very good	10.80	12.50	17.30	15.40	0.70	0.81	1.12	0.034
Good	51.70	44.90	48.70	47.80	1.08	0.94	1.02
Fair/bad	37.40	42.50	34.00	36.90	1.01	1.15	0.92
Cognitive deficit (MEEM) (1,263)
Yes	19.70	12.60	7.20	9.30	2.12	1.35	0.77		< 0.001
Psychiatric or nervous problem (1,261)
Yes	4.10	12.50	10.50	10.70	0.38	1.17	0.98	0.049
Depression (1.259)
Yes	13.80	13.40	20.40	17.80	0.78	0.75	1.15	0.013

Variables	Frequency (%)			Total	Prevalence Ratio			p-value
Variables	Black	Brown	White	Total	Black	Brown	White	p-value
Smoking in life (1,261)
Currently smoking	9.40	14.20	11.60	12.20	0.77	1.16	0.95	0.007
Has smoked	52.30	39.60	33.60	36.80	1.42	1.08	0.91
Never smoked	38.30	46.10	54.80	51.00	0.75	0.90	1.07
Risk for alcohol dependence (362)
No	89.30	77.30	93.40	89.00	1.00	0.87	1.05	0.001
Yes	10.70	22.70	6.60	11.00	0.97	2.06	0.60	0.001
Care for their own health (n=867)
Often	77.20	78.70	86.20	83.60	0.92	0.94	1.03	0.033
Once in a while/rarely	10.80	10.30	7.50	8.50	1.27	1.21	0.88
Never	12.00	11.00	6.30	7.90	1.52	1.39	0.80

Variables	Frequency (%)			Total	Prevalence Ratio			p-value
Variables	Black	Brown	White	Total	Black	Brown	White	p-value
Insurance health plan besides SUS (1,263)
Yes	25.70	30.20	53.10	44.10	0.58	0.68	1.20	< 0.001
No	74.30	69.80	46.90	55.90	1.33	1.25	0.84	< 0.001
Mean price paid for insurance health plan (R$) (95%CI) (561)	119.84 (65.96; 173.72)	172.33 (116.75; 227.92)	314.29 (276.95; 351.63)	275.20 (242.83; 309.57)
Difficulty to use health services (1,255)
No	75.00	75.00	74.00	74.40	1.01	1.01	0.99	0.91
Did additional tests (638)
Yes, did them all	61.80	64.80	77.30	72.50	0.85	0.89	1.07	0.011
No, but they are scheduled	25.60	22.70	17.10	19.40	1.32	1.17	0.88
No or just some	12.50	12.50	5.60	8.10	1.54	1.54	0.69
Need for urgency care (1,263)
Yes	16.30	25.00	20.10	21.30	0.77	1.17	0.94	0.13
No	83.70	75.00	79.90	78.70	1.06	0.95	1.02	0.13
Place of urgency/emergency care (289)
SUS	80.30	81.00	49.20	62.30	1.29	1.30	0.79	< 0.001
Health insurance plan	19.70	18.50	48.00	35.80	0.55	0.52	1.34
Private	0.00	0.60	2.80	1.80	0.00	0.33	1.56

Associação Brasileira de Saúde Coletiva Av. Dr. Arnaldo, 715 - 2º andar - sl. 3 - Cerqueira César, 01246-904 São Paulo SP Brasil , Tel./FAX: +55 11 3085-5411 - São Paulo - SP - Brazil
E-mail: revbrepi@usp.br

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[1] Corresponding author: Alexandre da Silva. Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade deSão Paulo. Avenida Doutor Arnaldo, 715, 1º andar, Pinheiros, CEP: 01246-904, São Paulo, SP, Brasil. E-mail: alesilva@usp.br