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

schooling compared to 23.2% of elderly men. The data show that, despite the progress,
there number of elderly persons with no education in the country remains high, which
makes education an important factor in determining health conditions.
Education produced a greater effect on hypertension than income. This can be
explained by the fact that high blood pressure is directly related to lifestyle and also
because lack of adherence to treatment is one of the greatest problems in controlling
blood pressure, both of which directly influenced by education level. Excessive use of
salt and high-sodium condiments associated with the consumption of fatty meats, fried
foods, sugars and little physical activity depend much more on education than income.
This study points to the existence of socioeconomic differences in cardiovascular
morbidity. As with hypertension, schooling introduces major effects. Heart disease
is concentrated in the lower socioeconomic levels. Education is an important factor
for the adoption of certain behaviors and lifestyles which mitigate or counter the
development of this disease. In addition, having less education implies less access
to the benefits of prevention and treatment. In Brazil, cardiovascular diseases are the
number one cause of death in the 60+ age group.
Socioeconomic status and gender had varying intensities and inter-relations
in their influences on the health of Brazilians (Chor, 2013). The gender paradox
in health is widely recognized (Lamb, 1997). However, the reasons why women
enjoy greater longevity but worse health are complex and are generally attributed
to differences in socioeconomic status, genetic and acquired risks, immune-system
responses, hormones, disease patterns and prevention, and health-reporting behaviors
(Crimmins and Saito, 2000; Idler, 2003; Oksuzyan, Juel, Vaupel et al., 2008). The
contribution of each sex to total averages differs for several chronic diseases. Gender
inequality significantly influences health and wellbeing because it affects most of the
determinants of health, including education, occupation, income, social networks,
physical and social environment and health services (Plouffe, 2003). Socioeconomic
inequality affects the health of women more negatively than men. This study is
consistent with there being a slight advantage in favor of high education compare to
st
high income with regard to women’s health. Brazilian women entered the 21 century
with higher educational levels than men, with a persistent difference that has increased
over time in favor of women. The country displays a process of increasing educational
levels overall and the reversal of the gender gap. Formerly, at older ages in all cohorts,
men had higher levels of education than women. However, in younger cohorts, women
have started to exceed men since the mid-twentieth century (Alves and Corrêa, 2009).
The novel contribution of this study was the use of morbidity data with
representation at the national level at two periods in time (1998 and 2008), which
allowed the monitoring of their evolution over time and ensured comparability. Few
studies on Brazil use information on the prevalence of chronic diseases which can
be considered as a representative sample of the population. We also recognize some
limitations of this study. First, our analyses focused exclusively on the prevalence
of health conditions with cross-sectional data, which prevented causal inferences.
Unfortunately, Brazil does not have longitudinal studies for this specific subject matter.
Second, an important limitation of this study was the use of self-reported morbidity
information relating to the presence of chronic diseases, which may be subject to
diagnosis bias and avoidance of diagnosis. That morbidity information helps identify
individuals who have received the diagnosis at least once in their life, but omits those
unaware of the condition and may lead to underestimation of the prevalence. Third,
accuracy of self-reporting may also vary by socioeconomic status and access to health
insurance. It is possible that those with higher education and income, and thus with
higher access to health insurance on average, are more aware of their health. However,
if this were to be the case, we would have expected higher prevalence among people
with higher education and income. We observed the opposite, thus indicating that
this issue is unlikely to explain our estimates of the educational and income gradients
in chronic disease over time. It is also possible that those with lower education and
income have more difficulty understanding the health diagnosis and answering the

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