Cover Image

The influence of socioeconomic deprivation, access to healthcare and physical environment on old-age survival in Portugal

Ana Isabel Ribeiro, Elias Teixeira Krainski, Marilia Sá Carvalho, Maria de Fátima de Pina
  • Ana Isabel Ribeiro http://orcid.org/0000-0001-8880-6962
    EPIUnit-Instituto de Saúde Pública, Universidade do Porto; i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto; INEB-Instituto de Engenharia Biomédica, Universidade do Porto; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal | anaisabelribeiro@med.up.pt
  • Elias Teixeira Krainski
    The Norwegian University for Science and Technology, Trondheim, Norway; Departamento de Estatística, Universidade Federal do Paraná, Curitiba, Brazil
  • Marilia Sá Carvalho
    PROCC-Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
  • Maria de Fátima de Pina
    i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto; INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Portugal; ICICT/FIOCRUZ-Instituto de Comunicação e Informação Científica e Tecnológica em Saúde/Fundação Oswaldo Cruz, Rio de Janeiro; CARTO-FEN/UERJ-Departamento de Engenharia Cartográfica, Faculdade de Engenharia da Universidade do Estado do Rio de Janeiro, Brazil

Abstract

Spatial inequalities in old-age survival exist in Portugal and might be associated with factors pertaining to three distinct domains: socioeconomic, physical environmental and healthcare. We evaluated the contribution of these factors on the old-age survival across Portuguese municipalities deriving a surrogate measure of life expectancy, a 10-year survival rate that expresses the proportion of the population aged 75-84 years old who reached 85-94. As covariates we used two internationally comparable multivariate indexes: the European deprivation index and the multiple physical environmental deprivation index. A national index was developed to evaluate the access to healthcare. Smoothed rates and odds ratios (OR) were estimated using Bayesian spatial models. Socioeconomic deprivation was found to be the most relevant factor influencing old-age survival in Portugal [women: least deprived areas OR=1.132(1.064-1.207); men OR=1.044(1.001- 1.094)] and explained a sizable amount of the spatial variance in survival, especially among women. Access to healthcare was associated with old-age survival in the univariable model only; results lost significance after adjustment for socioeconomic circumstances [women: higher access to healthcare OR=1.020(0.973- 1.072); men OR=1.021(0.989-1.060)]. Physical environmental deprivation was unrelated with old-age survival. In conclusion, socioeconomic deprivation was the most important determinant in explaining spatial disparities in old-age survival in Portugal, which indicates that policy makers should direct their efforts to tackle socioeconomic differentials between regions.

Keywords

Inequalities; Ageing; Spatial analysis; Geographic Information Systems; Portugal

Full Text:

PDF
Submitted: 2017-04-29 17:41:09
Published: 2017-11-07 10:44:41
Search for citations in Google Scholar
Related articles: Google Scholar
Abstract views:
52

Views:
PDF
24

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


Copyright (c) 2017 Ana Isabel Ribeiro, Elias Teixeira Krainski, Marilia Sá Carvalho, Maria Fátima Pina

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
 
© PAGEPress 2008-2017     -     PAGEPress is a registered trademark property of PAGEPress srl, Italy.     -     VAT: IT02125780185