Socioeconomic inequality and mortality risks in Brazil: An ecological study using governmental databases

The Brazilian Constitution states that everybody has the right to public health care and the government should provide it, through social and economic policies. In addition to the public health services, that is universal and comprehensive in Brazil, about 25% of the population has duplicate access to health care through private health insurance. Some national researches have been argued about the relationship between income level and people coverage by private health insurance. But, to what extent this set can affect the population health? The objective of this study was to compare brazilian municipalities by socioeconomic level, coverage by private health insurance and cause-specific mortality. An ecological study was conducted using national databases. Probabilistic record linkage was applied to obtain mortality data of people insured by health plans. We took as socioeconomic indicators: the human development index at municipal level (HDI-M), per capita income, years of study, life expectancy, poverty intensity, gini index, access to mains water and refuse collection in each municipality. The mortality indicators analyzed were selected based on their ability to provide markers for the extremes of the epidemiological transition process. We used the mortality rate by infectious diseases as an indicator of underdevelopment. The combined mortality rate by cancer and cardiovascular diseases was used to indicate advanced levels of development. The results showed that there is a positive correlation between coverage by health insurance and socioeconomic level. Socioeconomic indicators and coverage by health insurance were directly associated with mortality by cardiovascular diseases and cancer, which seems to be related to later stages of demographic and epidemiological transition process. On the other hand, mortality by infectious diseases was associated with lowest socioeconomic levels and local inequality. Furthermore, people insured by health plans die later and by diseases similar to the profile found in developed countries.