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Socioeconomic differentials and disease-free life expectancy of the elderly in Brazil

than in men at both ages. Nevertheless, they experience greater median survival with
heart disease than men. This finding is consistent with previous studies showing that
women generally have greater insight into disease, are more likely to pursue self-
care and seek more medical care than men, all of which would tend to increase the
likelihood of having the disease diagnosed and controlled. In contrast, studies highlight
that men have higher specific mortality rates, which causes them to leave the cohort
earlier (Puts, Lips and Deeg, 2005). Having more education tends to improve this
scenario by reducing the average total number of years spent living with heart disease.
There is an advantage in favor of the group with more education compared to the
group with higher income, among women. That is, the effect of education is strongest
among women.
With regard to those diagnosed with diabetes, DFLE rose between the periods for
both sexes. Average time without diabetes was higher among low income groups,
except for women 60 years of age. The value of DFLE was higher among those with
less education in the two periods analyzed, except for women aged 60 in 1998 and
women of both ages in 2008. One likely explanation is that women are more attuned
to recognizing symptoms and recalling disease history, which may influence their
reported diseases. Socioeconomic inequalities were not large, except for the highly
educated group of women among whom we found larger differences involving longer
disease-free survival and less average time spent living with the disease compared to
the high income group. For men, income played a much more evident influence.
Respiratory disease-free survival showed no important differences when comparing
income and education. The greatest differences were found in 1998, when those with
less education lived more years on average with disease. Women had longer survival
with the disease than men of all ages considered, periods and socioeconomic status.
Despite these dissimilar changes between the chronic diseases, this study
documented consistent decline in disease-free life expectancy for most chronic
diseases investigated in Brazil. Diabetes was the only one of these chronic diseases
to increase in disease-free life expectancy. There are some possible explanations for
the results found in this study. The first is that elderly Brazilians are living longer. The
current trend is that more individuals are living longer and have a larger number of
chronic conditions (Chaimowicz, 1998). According to Robine and Michel (2004), the
patterns of change in health can be partly attributable to the stage of the epidemiologic
transition in a given country. Gu et al. (2009) suggests that improvements in health
occurred during periods of rapid economic development and epidemiologic transition.
Brazil has experienced mostly sustained economic growth and a rapid epidemiologic
transition progresses since the 2000s. However, the disease-free life expectancy is
decreasing for most diseases between 1998 and 2008.
There is some evidence to suggest that the worsening health trend in Brazil and the
changes in health indicated in the present study can be explained by the compression
of morbidity and expansion of morbidity hypotheses (Fries, 1980; Gurenberg, 1977).
The expansion of morbidity theory puts forward the pessimistic view that the gains in
life expectancy are predominantly through the technological advances that have been
made in extending the life of those with disease. In addition, living longer exposes
more people to the non-fatal diseases of old age. Overall, our findings support the
expansion of morbidity hypothesis for older adults in Brazil between 1998 and 2008
for hypertension, bronchitis/asthma and heart disease. On the other hand, the opposing
theory is that of compression of morbidity. According to this theory, changes in
lifestyle, which modify the risk factors for mortality, will also delay the age-at-onset
and the progression of non-fatal diseases. Thus, the time lived with disease will be
compressed into a shorter period before death. The results found for diabetes in Brazil
indicate some evidence that support the compression of morbidity theory.
The findings of the present study for most of the chronic diseases suggest a possible
cohort effect in the country. Younger elderly women showed a trend of morbidity
compression. Moreover, over the period it was noted this effect. These findings support
the argument that cohort replacement gradually produces a compression of morbidity

72 International Journal of Population Studies 2017, Volume 3, Issue 1