Area deprivation measures used in Brazil: a scoping review

Ichihara, Maria Yury Travassos; Ramos, Dandara; Rebouças, Poliana; Oliveira, Flávia Jôse; Ferreira, Andrêa J. F.; Teixeira, Camila; Allik, Mirjam; Katikireddi, Srinivasa Vittal; Barreto, Mauricio L.; Leyland, Alastair H; Dundas, Ruth

doi:10.11606/S1518-8787.2018052000933

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Review • Rev. Saúde Pública 52 • 2018 • https://doi.org/10.11606/S1518-8787.2018052000933 linkcopy

Area deprivation measures used in Brazil: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To describe and assess currently used area-based measures of deprivation in Brazil for health research, to the purpose of informing the development of a future small area deprivation index.

METHODS We searched five electronic databases and seven websites of Brazilian research institutions and governmental agencies. Inclusion criteria were: studies proposing measures of deprivation for small areas (i.e., finer geography than country-level) in Brazil, published in English, Portuguese or Spanish. After data-extraction, results were tabulated according to the area level the deprivation measure was created for and to the dimensions of deprivation or poverty included in the measures. A narrative synthesis approach was used to summarize the measures available, highlighting their utility for public health research.

RESULTS A total of 7,199 records were retrieved, 126 full-text articles were assessed after inclusion criteria and a final list of 30 articles was selected. No small-area deprivation measures that have been applied to the whole of Brazil were found. Existing measures were mainly used to study infectious and parasitic diseases. Few studies used the measures to assess inequalities in mortality and no studies used the deprivation measure to evaluate the impact of social programs.

CONCLUSIONS No up-to-date small area-based deprivation measure in Brazil covers the whole country. There is a need to develop such an index for Brazil to measure and monitor inequalities in health and mortality, particularly to assess progress in Brazil against the Sustainable Development Goal targets for different health outcomes, showing progress by socioeconomic groups.

DESCRIPTORS
Poverty; Poverty Areas; Socioeconomic Factors; Social Inequity, classification; Social Indicators; Review

Characteristics		n (%)
Publication year
	2000-2010	15 (50)
	2011-2017	15 (50)
Area level²
	Municipalities	9 (30)
	Census tracts	6 (20)
	Districts	5 (17)
	Neighborhoods	4 (13)
	Others	6 (20)
Health outcomes²
	Infant/Childhood mortality	6 (20)
	Homicides	4 (13)
	Teenage pregnancy	2 (7)
	Infectious/Parasitic diseases	10 (33)
	Mortality	2 (7)
	Oral health	3 (10)
	Others	2 (7)
	No study of health outcomes	6 (20)

Author (year)	Dimension	Indicators
		Municipality
Barata et al.³⁸ (2000)	Income	Average monthly income of household heads; Gini coeficient; Income concentration index (ratio between the income of the 90th percentile/income of the 20th; percentile).
Bezerra Filho et al.³³ (2007)	Income Sanitary conditions Housing conditions Education	Proportion of financial resources to health in the municipality; proportion of household heads according to income in minimum wages; proportion of children from 10 to 14 years old working; proportion of the value of vegetal production compared to the total of the state, proportion of rural, industrial, commercial energy use on the total of the municipality, per capita gross domestic product; intensity of poverty (line of R$37.75) and IDHM Income; Proportion of the population with access to a public supply of water, sewage facilities, trash collection; access to power supply; Proportion of small houses (two or less rooms); Proportion of people living in a house with telephone; Proportion of illiterate children from seven to 14 years old, proportion of children from seven to 14 not in school, literacy rate among adults, average number of schooling years of people who were 25 or older; proportion of literate women and proportion of women with < 8 years of schooling; and component for education of the Human Development Index (IDH).
Drachler et al.³⁴ (2014)	Income Sanitary conditions Education Other	Proportion of households with monthly income below 1/2 minimum wage; Proportion of households not connected to the water distribution system; proportion of households with no connection to the sewage system; proportion of households without waste or garbage collection; Proportion of illiteracy among people above 15 year of age; Demographic density.
Ottoneli et al.³⁵ (2014)	Income Sanitary conditions Housing conditions Education Other	Average income of the households; proportion of households with income below 1/2 of the minimum wage; Proportion of households with access to the sewage system; proportion of households with access to the water distribution system; proportion of households with access to garbage removal or collection; proportion of households with a bathroom; Proportion of households with electricity; Proportion of households with density of dwellers above 2; Proportion of households with refrigerators; literacy rate of people above five years of age; proportion of illiterate people between five and 14 years of age; proportion of illiterate people above 15 years of age; proportion of households where the head of the household was illiterate; proportion of people above 10 years of age with no schooling or below 5th grade; proportion of people above 10 years of age who completed high school; infant mortality; child mortality (under-5); proportion of children and adolescents (10–17 years) who had children.
Costa et al.⁵² (2016)	Income Housing conditions Education Other	Percentage of poor people; Percentage of households built with durable material; Illiterates aged 15 or over; Infant mortality per 100 thousand live births.
Vieira et al. (2017)⁶³	Income Sanitary conditions Housing conditions Education Working/ Employment	Household income [R$154.00/person living at home (in 2010)]; 1/2 minimum wage per capita (in 2000); Water supply (general network with internal conduits, general network without internal conduit, well or spring with internal piping, well or spring without internal piping, other way); sanitary facilities (no or yes access to toilet facilities); type of drainage system for toilets (general network, septic tank, rudimentary fossa, another sewer); waste destination (collected by cleaning service, collected in cleaning service bucket, burned, buried, played in wasteland, played in river, lake or sea; another destination); Number of bathrooms at home (no bathroom or at least one); Condition of occupation of the property (owned, leased, given by an employer, assigned otherwise, another condition); electricity (yes or no at the household); goods (cable TV, refrigerator and washing machine); Literacy and non literacy; years of education (no education or less than three years of study; from four to seven years; from eight to 10 years; from 11 to 14 years; 15 or more years of study); Employment (no or yes – access to a job).
Castro et al.⁵⁹ (2016)	Income Working/ Employment Other	Gini index (income inequality of household heads); average household income per capita; proportion of the poor population (those with per capita income below half the minimum wage); proportion of poor children; Unemployment rate of the population aged 18 years or older; Municipal Human Development Index (IDHM).
Cortellazzi et al.⁵³ (2014)	Income Housing conditions Education Other	Per capita income; Population density; Educational level of the adult population; educational flow of the younger population; Municipal Human Development Index (IDHM).
Junior et al.⁶⁰ (2014)	Income Sanitary conditions Education	Per capita income (the mean declared monthly income in multiples of the minimum wage); Basic sanitation (percentage of households connected to public sewage or drainage system); refuse collection (percentage of households with public refuse collection); public water supply (percentage of households connected to a public water supply); Literacy rate (the percentage of the population able to read and write).
		Census tracts
Szwarcwald et al.⁵⁵ (2002)	Income	Index of heterogeneity of poverty concentration among sub-areas – household head monthly income.
Bonfim et al.³⁶ (2009)	Income Sanitary conditions Housing conditions Education	Proportion of heads of households with an income of half to one minimum monthly salary; Proportion of households with water supply from wells or springs only in the yard of the property, not piped, and other forms of water supply; proportion of households with sewage disposal into a rudimentary cesspit, ditch or gutter, or into a river, a lake or the sea, and without a bathroom; proportion of households in which garbage is burned, buried, dumped on vacant land or in rivers, or other destinations; proportion of households that are not owner-occupiers or living in rented or assigned property; proportion of households consisting of 10 people or more; Proportion of heads of households with not more than one year of schooling.
Bonfim et al.³⁷ (2011)	Income Sanitary conditions Housing conditions Education	Proportion of heads of households with an income between 0.5 and 1.0 minimum wages; Proportion of households with inadequate water supply; proportion of households with inadequate sewage sanitary; proportion of households with inadequate solid waste collection; proportion of households with ten or more residents; proportion of rented households; proportion of heads of households with < 1 year of schooling; proportion of the population aged between 10 and 14 years with no schooling.
Hino et al.³⁸ (2011)	Income Housing conditions Education	Proportion of household heads with income below two minimum wage; Household density; Proportion of illiterate people between ages 10–14; proportion household heads with less than three years of formal education.
Dias et al.⁶¹ (2016)	Income Sanitary conditions Housing conditions Education Other	Income (per capita income up to 1/2 minimum wage, responsible people's average income); Sanitation (inadequate water supply, inadequate sanitary sewage, inadequate garbage collection); Housing (residents per household); Education (illiterate population); Social (black and indigenous people's percentage).
Santos et al.⁶² (2007)	Income Housing conditions Education	Average income (in Reais) of people responsible for each household; average income (in Reais) of the women responsible for each household; Rate of households with more than five inhabitants; Average years of schooling of people responsible for each household; average years of schooling of the women responsible for each household; rate of illiterate people over five years of age; rate of illiterate women over five years of age.
		Districts
Lima et al.⁴¹ (2005)	Income Education Other	Per capita family income, inequality index, Gini index, average income of the head of the family, poverty index; Rate of illiteracy; Demographic density.
D’Ambrosio et al.⁴⁰ (2008)	Housing conditions Education Working Employment Other	Lives in a favela; his or her dwelling is “improvised”; his or her dwelling is one-room type; his or her dwelling is overcrowded; Does not have (or has not had) access to formal education; Uemployed; domestic paid worker; Lives in a rural area; lives in a polluted area; lives in a place not served by good urban services; does not have access to a minimum standard of consumption.
Bonfim et al.³⁶ (2009)	Income Sanitary conditions Housing conditions Education	Proportion of heads of households with an income of half to one minimum monthly salary; Proportion of households with water supply from wells or springs only in the yard of the property, not piped, and other forms of water supply; proportion of households with sewage disposal into a rudimentary cesspit, ditch or gutter, or into a river, a lake or the sea, and without a bathroom; Proportion of households in which garbage is burned, buried, dumped on vacant land or in rivers or other destinations; proportion of households that are not owner-occupiers or living in rented or assigned property; Proportion of households with 10 people or more; Proportion of heads of households with not more than one year of schooling.
Oliveira et al.⁴² (2009)	Income Sanitary conditions Education	Income; Sanitary household conditions; water quality; Schooling.
Antunes et al.³⁹ (2002)	Income Sanitary conditions Housing conditions Working/Employment	Household income; Gini coefficient for income inequality; Water supply; Household overcrowding; Unemployment rate.
		Neighborhood
Duarte et al.⁴⁵ (2006)	Income Sanitary conditions Education Other	Income level of the household head; Proportion of households with access to the sewage and water distribution system; proportion of households with access to garbage removal; Coverage of daycare centers for children below four years of age; school coverage for children with ages between 4–6; Concentration of female illiteracy; Coverage of basic health unit per 5.000 inhabitants; Concentration of women as household heads; Concentration of precarious households.
Lopes et al.⁴⁶ (2015)	Income Sanitary conditions Housing conditions Education	Proportion of people below the poverty line; Proportion of household in adequate living conditions; proportion of households with a bathroom; Proportion of households with more than seven people; Proportion of illiterate people.
De Holanda et al.⁴³ (2015)	Housing conditions Education Other	Proportion of homes in the poverty range; Illiteracy rate; illiterate women responsible for the home; Pregnant women without prenatal care.
De Sousa et al.⁴⁴ (2014)	Income Sanitary conditions Education Other	Average nominal income; per capita income; proportion of people with high incomes; Proportion of heads of households under the poverty line and below it; proportion of poor households; Proportion of households with water supply; proportion of households with garbage collection; Proportion of heads of households in relation to years of education; average years of education; proportion of people with early and late literacy; Human Development Index per neighborhood; Proportion of youth and longevity.
		Other areas
Szwarcwald et al.⁷ (2000)	Income	Proportion of household heads who earned less than one “minimum wage” per month.
Rocha et al.⁴⁹ (2000)	Other	Food expenses (food basket).
Teixeira et al.⁵¹ (2002)	Other	No Information.
Barros et al. ⁵⁴ (2003)	Income Sanitary conditions Housing conditions Education Working Employment Other	Income; familiar income; Access to water supply, sewage system electricity, garbage collection and goods; Type of residence; Schooling by age; Professional qualification; number of children out of school in the family; Number of people active for work and occupied; Number of live births; Presence of children, adolescents, young people and older adults in the family; presence of the mother in the family; presence of mother who has had stillbirth or a child who has died; Density of residents.
Barbieri et al.⁴⁸ (2015)	Income Sanitary conditions Education Working/ Employment Other	Proportion variation in GRP; Proportion of households with proper sanitation; Expected education; Proportion variation in employment; Average prevalence of dengue; average prevalence of respiratory diseases; average prevalence of infectious diseases; proportion variation in family consumption; government transfer support ratio; proportion of municipalities with risk management plan; total dependency ratio.
Antunes et al.⁴⁷ (2004)	Income Education Other	Income; insufficient Income; Illiteracy rate; Human Development Index; Child Development Index.
Souza et al.⁵⁰ (2012)	Income Sanitary conditions Housing conditions Education Other	Income (proportion of heads of family in permanent private households with a mean monthly income ≤ 2 minimum salaries); Sanitation (percentage of households with an internal water supply connected to the mains); Slum (percentage of households within subnormal clusters); agglomeration (ratio of inhabitants per room); Education (proportion of literate individuals aged 10–14 years in the population); Living conditions index (LCI).

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E-mail: revsp@usp.br

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This categorization refers to the terms used by the authors on the reviewed studies. The sum adds to more than 30 because some studies created measures for more than one area-level, simultaneously.