Revista de Saúde Pública
On-line version ISSN 1518-8787
CHIAVEGATTO FILHO, Alexandre Dias Porto; GOTLIEB, Sabina Léa Davidson and KAWACHI, Ichiro. Cause-specific mortality and income inequality in São Paulo, Brazil. Rev. Saúde Pública [online]. 2012, vol.46, n.4, pp.712-718. Epub June 19, 2012. ISSN 1518-8787. http://dx.doi.org/10.1590/S0034-89102012005000039.
OBJECTIVE: To analyze cause-specific mortality rates according to the relative income hypothesis. METHODS: All 96 administrative areas of the city of São Paulo, southeastern Brazil, were divided into two groups based on the Gini coefficient of income inequality: high (>0.25) and low (<0.25). The propensity score matching method was applied to control for confounders associated with socioeconomic differences among areas. RESULTS: The difference between high and low income inequality areas was statistically significant for homicide (8.57 per 10,000; 95%CI: 2.60;14.53); ischemic heart disease (5.47 per 10,000 [95%CI 0.76;10.17]); HIV/AIDS (3.58 per 10,000 [95%CI 0.58;6.57]); and respiratory diseases (3.56 per 10,000 [95%CI 0.18;6.94]). The ten most common causes of death accounted for 72.30% of the mortality difference. Infant mortality also had significantly higher age-adjusted rates in high inequality areas (2.80 per 10,000 [95%CI 0.86;4.74]), as well as among males (27.37 per 10,000 [95%CI 6.19;48.55]) and females (15.07 per 10,000 [95%CI 3.65;26.48]). CONCLUSIONS: The study results support the relative income hypothesis. After propensity score matching cause-specific mortality rates was higher in more unequal areas. Studies on income inequality in smaller areas should take proper accounting of heterogeneity of social and demographic characteristics.
Keywords : Mortality; Cause of Death; Income; Health Inequalities; Social Inequity.