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Race, sex and depression-free life expectancy in Brazil, 1998–2013

(Keppel, 2007). The importance of the relationship between health and race has been demonstrated through continuous
investigation and inclusion of race and skin color as study variables in a plethora of studies (Barr, 2008; Williams and
Mohammed, 2009). As a matter of fact, racial inequalities in different health outcomes are persistent, especially in
countries where Afro descendants have experienced the disadvantages and burden of injustices derived from historical
structural processes in societies, such as slavery and racism (LaVeist, 2005). As an example, in the United States, the life
expectancy at birth for whites was 3.4 years higher than for African Americans in 2014. This racial difference was even
higher in men, 4.2 years (CDC, 2016).
Brazil has an intense race mixing. The Brazilian Demographic Census in 2010 showed a country divided between
whites and non-whites, with 47.7% whites skin color, 7.6% blacks, 43.1% brown (pardos), 1.1% Asians, and 0.43%
indigenous (IBGE, 2010).
In Brazil, race is directly associated with the individual’s socioeconomic situation. Non-whites face severe
socioeconomic disadvantages when compared to whites (Souza, Ribeiro, and Carvalhaes, 2010). Brazilian black and
brown populations are poorer and have a lower educational attainment. In the latest census, approximately 66.7% of
blacks and browns did not receive any education, whereas only 31.3% of whites did not have any years of schooling;
whites earned an average higher monthly income than blacks: about 54.8% of blacks and browns did not have income
compared to 43.6% of whites (IBGE, 2010).
Racial disparities as measured by different health indicators exist and persist in the country. Nevertheless, understanding
the role of different diseases and pathways in the disparities is still a major research gap in Brazil. Methodological
limitations have been cited as obstacles to studies on race and health. For example, in disease-specific mortality rates by
race, the fact that the numerator and denominator come from different data sources purportedly limits the results accuracy
(Chor, 2013). Furthermore, difficulties emerge in the measurement of race. Although death certificates contain a question
about the race of the individuals, it is generally poorly completed, thus failing to provide a faithful account of deaths
by race. For that reason, it is difficult to estimate life tables for different race categories. Among studies with relatively
completed race data, a city-specific study, using data with up to 81% of completeness of race/color categories, showed
the existence of unequal mortality by race, with higher mortality from mental disorders and external causes in blacks
(Fiorio, Flor, Padilha et al., 2011). Furthermore, in Brazil, another alleged problem is the race variability with which
some individuals classify themselves. As in other countries, racial identity in Brazil is not immutable, and its validity and
reliability are low (Chor, 2013).
Depression is a common mental disorder affecting people's mental health worldwide. It has a great burden of disease
also in Brazil, especially for women where is the leading cause of burden of disease (Leite, Valente, Schramm et al.,
2015). The under-diagnosis of depression is a serious health problem, particularly in countries such as Brazil in which
many residents lack adequate access to healthcare services for diagnosis and treatment (Andrade, Wu, Lebrão et al.,
2016). One study found that depressive symptoms affect one in seven Brazilian adults, that one in 12 people over the
age of 18 have a major depressive disorder, that the pooled prevalence of depression, considering a recall period of one
year was 8%, and that the prevalence of depressive symptoms, including different recall periods for each study, ranged
from 5% to 28% (Silva, Galvao, Martins et al., 2014). Results from the 2013 Brazilian National Health Survey (PNS),
a nationwide household population-based survey, whose data were obtained through in-home visits, indicated that the
prevalence of self-reported diagnosis of depression in adults was 7.6% (Stopa, Malta, de Oliveira et al., 2015). The
prevalence of depressive symptoms in women is estimated to be twice as high as in men (Silva, Galvao, Martins et al.,
2014). Depression can be a serious condition and could impact several dimensions of a person’s quality of life, work,
functioning, and even lead to suicide in more severe cases (WHO, 2016).
There is no consistent pattern among international studies about which race has a higher prevalence of depression
and which has a lower prevalence (Riolo, Nguyen, Greden et al., 2005). Moreover, few studies have focused on race
differences in specific chronic diseases, such as depression, especially in developing countries.
Healthy life expectancy is a measure that combines morbidity and mortality information into a single index. It presents
a similar concept to life expectancy, but refers to the average number of years of life that a person of a certain age can
expect to live healthy, given prevailing morbidity and mortality rates in a particular age (Jagger, Hauet, and Brouard,
2001). Bone et al. (1998) point out that healthy life expectancy can be used to observe population health trends and to
monitor the impact of health and social policies, and allow comparison between different populations and subgroups.
There is growing body of literature about healthy life expectancy in Brazil (Alves and Arruda, 2017; Andrade, Wu,
Lebrão et al., 2016; Camargos, Perpétuo, and Machado, 2005; Campolina, Adami, Santos et al., 2013; Romero, Leite, and
Szwarcwald, 2005; Tareque and Saito, 2017; Zimmer, Hidajat, and Saito, 2015), however, we have not identified studies
that explore race differences in health expectancy considering depression (depression-free life expectancy) and no studies

2 International Journal of Population Studies | 2018, Volume 4, Issue 1