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Alves LC and Arruda NM

as mortality continues to decline and new cohorts have better profiles of health and
risky behaviors (Robine and Michel, 2004).
Chronic non-communicable diseases, especially hypertension and diabetes, and their
inherent complications such as heart diseases and the related morbidity and mortality,
are currently the most common public health problems and contribute most to the
burden of disease in Brazil. Despite the substantial investment and improvement in the
Brazilian National Health System (SUS), the diagnosis and control of hypertension
and diabetes are still lower than in countries with similar health care models (Campbell,
McAlister and Quah, 2013; Ordunez-Garcia, Munoz, Pedraza et al., 2006). The
findings of our study indicate that the lowest socioeconomic level had improvements
in DFLE for diabetes and heart disease. This may be due to a higher rate of conditions
going undiagnosed among the elderly whose socioeconomic situations are more
unfavorable, for both sexes, more so due to their lower accessibility to healthcare
facilities in this period than a trend towards a compression of morbidity in this group.
During the epidemiologic transition, men and women may experience different
trends. With increased longevity, women as a group usually tend to have a higher
overall prevalence or incidence of diseases and disability than men. In later stages of
epidemiological transition, differentials in socioeconomic status play a greater role in
affecting the prevalence, incidence and trends of disability because the socioeconomic
condition of individuals largely determines access to health care, environmental
exposure, nutritional status, lifestyle and behavioral risks that are important for
morbidity and mortality patterns (Gu, Gomez-Redondo and Dupre, 2015).
The results of this study corroborate previous research (Arber, 1991; House,
Lepkowski, Kinneyet et al., 1994; Kaplan, Pamuk, Lynch et al., 1996; Marmot, Ryff,
Bumpass et al., 1997), in that socioeconomic status plays a key role in determining
the health of individuals. Higher socioeconomic status leads to increased health.
Socioeconomic status is often measured by education and income. Income and
education have differing effects. Education, for example, encourages access to
information and the practice of healthy behaviors (Kubzansky, Berkman, Glass et
al., 1998). Education provides several advantages for health because it influences
psychosocial and behavioral factors. Older people with a higher level of education are
less likely to expose themselves to risk factors for diseases. Also, the less privileged
population has higher prevalence of risk factors which are already established and
considered as modifiable factors (dyslipidemia, hypertension, diabetes mellitus,
smoking, obesity, physical inactivity and stress). More education favors access
to information and lifestyle modification, the adoption of healthy habits, demand
for health services, and involvement in activities that prioritize health promotion,
especially correctly following recommended follow-up in relation to health. There is
also evidence that low income among the elderly negatively impacts healthy behavior,
in terms of the home environment, access to services and health care, even if these are
in principle available (Alves and Rodrigues, 2005). According to Lima-Costa et al.
(2003), the poorest elderly seek less health care, have poor adherence to treatment and
have little access to drugs, which directly affects the health of the individuals. Income
facilitates access to medical services (Zimmer and Amornsirisomboon, 2001). Higher
income provides greater opportunity to access goods and services, including quality
education and health care with effective diagnostic and therapeutic resources, including
skilled and sophisticated diagnostic equipment (Kaplan and Keil, 1993). This study
shows that education had a larger impact on life expectancy with disease and disease-
free life expectancy than income.
According to data from the Brazilian National Household Survey, in 1998, 26.2%
of the total population had less than one year of education, and among individuals 60
years of age the proportion was 31.6%. By 2008, it had changed to 20.0%, representing
a 23.7% reduction during the period. By sex, in 1998, elderly men were proportionally
more educated than women (27.9% versus 34.7%, respectively), as until the 1960s
men had more access to education than women. On the other hand, in 2008 there was
a reversal in the sense that 21.7% of elderly women aged 60 had less than one year of

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