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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2000 Jul;54(7):530–536. doi: 10.1136/jech.54.7.530

Health conditions and residential concentration of poverty: a study in Rio de Janeiro, Brazil

C Szwarcwald 1, F I Bastos 1, C Barcellos 1, M d Pina 1, M A Esteves 1
PMCID: PMC1731708  PMID: 10846196

Abstract

STUDY OBJECTIVES—To establish the geographical relation of health conditions to socioeconomic status in the city of Rio de Janeiro, Brazil.
DESIGN—All reported deaths in the municipality of Rio de Janeiro, from 1987 to 1995, obtained from the Mortality Information System, were considered in the study. The 24 "administrative regions" that compose the city were used as the geographical units. A geographical information system (GIS) was used to link mortality data and population census data, and allowed the authors to establish the geographical pattern of the health indicators considered in this study: "infant mortality rate"; "standardised mortality rate"; "life expectancy" and "homicide rate". Information on location of low income communities (slums) was also provided by the GIS. A varimax rotation principal component analysis combined information on socioeconomic conditions and provided a two dimension basis to assess contextual variation.
MAIN RESULTS—The 24 administrative regions were aggregated into three different clusters, identified as relevant to reflect the socioeconomic variation. Almost all health indicator thematic maps showed the same socioeconomic stratification pattern. The worst health situation was found in the cluster composed of the harbour area and northern vicinity, precisely in the sector where the highest concentration of slum residents are present. This sector of the city exhibited an extremely high homicide rate and a seven year lower life expectancy than the remainder of the city. The sector that concentrates affluence, composed of the geographical units located along the coast, showed the best health situation. Intermediate health conditions were found in the west area, which also has poor living standards but low concentration of slums.
CONCLUSIONS—The findings suggest that social and organisation characteristics of low income communities may have a relevant role in understanding health variations. Local health and other social programmes specifically targeting these communities are recommended.


Keywords: geographical information system; health conditions; low income communities

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Selected References

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  1. Adler N. E., Boyce W. T., Chesney M. A., Folkman S., Syme S. L. Socioeconomic inequalities in health. No easy solution. JAMA. 1993 Jun 23;269(24):3140–3145. [PubMed] [Google Scholar]
  2. Berkman L. F., Syme S. L. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol. 1979 Feb;109(2):186–204. doi: 10.1093/oxfordjournals.aje.a112674. [DOI] [PubMed] [Google Scholar]
  3. Croner C. M., Sperling J., Broome F. R. Geographic information systems (GIS): new perspectives in understanding human health and environmental relationships. Stat Med. 1996 Sep 15;15(17-18):1961–1977. doi: 10.1002/(sici)1097-0258(19960930)15:18<1961::aid-sim408>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  4. Duncan G. J. Income dynamics and health. Int J Health Serv. 1996;26(3):419–444. doi: 10.2190/1KU0-4Y3K-ACFL-BYU7. [DOI] [PubMed] [Google Scholar]
  5. Haan M., Kaplan G. A., Camacho T. Poverty and health. Prospective evidence from the Alameda County Study. Am J Epidemiol. 1987 Jun;125(6):989–998. doi: 10.1093/oxfordjournals.aje.a114637. [DOI] [PubMed] [Google Scholar]
  6. House J. S., Landis K. R., Umberson D. Social relationships and health. Science. 1988 Jul 29;241(4865):540–545. doi: 10.1126/science.3399889. [DOI] [PubMed] [Google Scholar]
  7. Humphreys K., Carr-Hill R. Area variations in health outcomes: artefact or ecology. Int J Epidemiol. 1991 Mar;20(1):251–258. doi: 10.1093/ije/20.1.251. [DOI] [PubMed] [Google Scholar]
  8. Kaplan G. A., Pamuk E. R., Lynch J. W., Cohen R. D., Balfour J. L. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996 Apr 20;312(7037):999–1003. doi: 10.1136/bmj.312.7037.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kaplan G. A. People and places: contrasting perspectives on the association between social class and health. Int J Health Serv. 1996;26(3):507–519. doi: 10.2190/4CUU-7B3G-G4XR-0K0B. [DOI] [PubMed] [Google Scholar]
  10. Kawachi I., Kennedy B. P. Health and social cohesion: why care about income inequality? BMJ. 1997 Apr 5;314(7086):1037–1040. doi: 10.1136/bmj.314.7086.1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kawachi I., Kennedy B. P., Lochner K., Prothrow-Stith D. Social capital, income inequality, and mortality. Am J Public Health. 1997 Sep;87(9):1491–1498. doi: 10.2105/ajph.87.9.1491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kennedy B. P., Kawachi I., Prothrow-Stith D. Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States. BMJ. 1996 Apr 20;312(7037):1004–1007. doi: 10.1136/bmj.312.7037.1004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Leal M. do C., Szwarcwald C. L. Características da mortalidade neonatal no estado do Rio de Janeiro na década de 80: uma visão espaço-temporal. Rev Saude Publica. 1997 Oct;31(5):457–465. doi: 10.1590/s0034-89101997000600003. [DOI] [PubMed] [Google Scholar]
  14. Marmot M. G., Kogevinas M., Elston M. A. Social/economic status and disease. Annu Rev Public Health. 1987;8:111–135. doi: 10.1146/annurev.pu.08.050187.000551. [DOI] [PubMed] [Google Scholar]
  15. Massey D. S. The age of extremes: concentrated affluence and poverty in the twenty-first century. Demography. 1996 Nov;33(4):395–416. [PubMed] [Google Scholar]
  16. Minayo M. C. Inequality, violence, and ecology in Brazil. Cad Saude Publica. 2004 Feb 3;10(2):241–250. doi: 10.1590/s0102-311x1994000200011. [DOI] [PubMed] [Google Scholar]
  17. Sampson R. J., Raudenbush S. W., Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997 Aug 15;277(5328):918–924. doi: 10.1126/science.277.5328.918. [DOI] [PubMed] [Google Scholar]
  18. Shouls S., Congdon P., Curtis S. Modelling inequality in reported long term illness in the UK: combining individual and area characteristics. J Epidemiol Community Health. 1996 Jun;50(3):366–376. doi: 10.1136/jech.50.3.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Szwarcwald C. L., de Castilho E. A. Estimativas da mortalidade infantil no Brasil, década de oitenta: proposta de procedimento metodológico. Rev Saude Publica. 1995 Dec;29(6):451–462. doi: 10.1590/s0034-89101995000600006. [DOI] [PubMed] [Google Scholar]
  20. Tim U. S. The application of GIS in environmental health sciences: opportunities and limitations. Environ Res. 1995 Nov;71(2):75–88. doi: 10.1006/enrs.1995.1069. [DOI] [PubMed] [Google Scholar]
  21. Vine M. F., Degnan D., Hanchette C. Geographic information systems: their use in environmental epidemiologic research. Environ Health Perspect. 1997 Jun;105(6):598–605. doi: 10.1289/ehp.97105598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Webster P. Review of the "City Health Profiles" produced by WHO-Healthy Cities--do they present information on health and its determinants and what are their perceived benefits? J Epidemiol Community Health. 1999 Feb;53(2):125–127. doi: 10.1136/jech.53.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Wilkinson R. G. Comment: income, inequality, and social cohesion. Am J Public Health. 1997 Sep;87(9):1504–1506. doi: 10.2105/ajph.87.9.1504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wilkinson R. G. Income distribution and life expectancy. BMJ. 1992 Jan 18;304(6820):165–168. doi: 10.1136/bmj.304.6820.165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Wilkinson R. G. National mortality rates: the impact of inequality? Am J Public Health. 1992 Aug;82(8):1082–1084. doi: 10.2105/ajph.82.8.1082. [DOI] [PMC free article] [PubMed] [Google Scholar]

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