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

  • Ana Isabel Ribeiro | anaisabelribeiro@med.up.pt 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. http://orcid.org/0000-0001-8880-6962
  • 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.

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Author Biography

Ana Isabel Ribeiro, 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

Ana Isabel Ribeiro was born in Porto in 1988. In 2008, she finished a BS in Geography, in 2010 a Master in Public Health, and in 2016 a PhD in Public Health at University of Porto with a grant from the Portuguese Foundation for Science and Technology (SFRH/BD/82529/2011).

 

She is currently a Researcher based at the Institute of Public Health of University of Porto working in the international project ‘Life-course biological pathways underlying social differences in healthy ageing (LIFEPATH)’ led by Imperial College of London and funded by the European Commission through Horizon 2020. She is also a member of the Department of Health and Society and of the research group on Social Epidemiology (EPIUnit).

 

She is particularly interested in understanding how the place of residence shapes individuals’ health and in evaluating the socioeconomic and environmental inequalities in health and health-related behaviours.

 

Since 2014 she has also been teaching the curricular units of Demography and Geographical Information Systems in the graduation programmes promoted by the Institute of Public Health and by the Faculty of Medicine of University of Porto.

Published
2017-11-07
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Original Articles
Keywords:
Inequalities, Ageing, Spatial analysis, Geographic Information Systems, Portugal
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How to Cite
Ribeiro, A. I., Krainski, E. T., Carvalho, M. S., & de Fátima de Pina, M. (2017). The influence of socioeconomic deprivation, access to healthcare and physical environment on old-age survival in Portugal. Geospatial Health, 12(2). https://doi.org/10.4081/gh.2017.581