Cause-specific mortality and income inequality in São Paulo, Brazil.
OBJECTIVE
To analyze cause-specific mortality rates according to the relative income hypothesis.


METHODS
All 96 administrative areas of the city of São Paulo, southeastern Brazil, were divided into two groups based on the Gini coefficient of income inequality: high (≥0.25) and low (<0.25). The propensity score matching method was applied to control for confounders associated with socioeconomic differences among areas.


RESULTS
The difference between high and low income inequality areas was statistically significant for homicide (8.57 per 10,000; 95%CI: 2.60;14.53); ischemic heart disease (5.47 per 10,000 [95%CI 0.76;10.17]); HIV/AIDS (3.58 per 10,000 [95%CI 0.58;6.57]); and respiratory diseases (3.56 per 10,000 [95%CI 0.18;6.94]). The ten most common causes of death accounted for 72.30% of the mortality difference. Infant mortality also had significantly higher age-adjusted rates in high inequality areas (2.80 per 10,000 [95%CI 0.86;4.74]), as well as among males (27.37 per 10,000 [95%CI 6.19;48.55]) and females (15.07 per 10,000 [95%CI 3.65;26.48]).


CONCLUSIONS
The study results support the relative income hypothesis. After propensity score matching cause-specific mortality rates was higher in more unequal areas. Studies on income inequality in smaller areas should take proper accounting of heterogeneity of social and demographic characteristics.
Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil. achiaveg@hsph.harvard.edu
Alexandre Dias Porto
AD
Chiavegatto Filho
Sabina Léa Davidson
SL
Gotlieb
Ichiro
I
Kawachi
D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D002423:Cause of Death; D002648:Child; D005260:Female; D054624:Health Status Disparities; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011203:Poverty; D057216:Propensity Score; D012923:Social Class; D014505:Urban Population; D055815:Young Adult