Social inequality in health and the utilization of health services among the elderly in Latin America

• Published in: Revista panamericana de salud pública Vol. 17; no. 5-6; pp. 410 - 418
• Main Authors: Noronha, Kenya Valéria Micaela de Souza, Andrade, Mônica Viegas
• Format: Journal Article
• Language: Portuguese
• Published: United States 01.05.2005
• Subjects: Age Factors; Aged; Aged, 80 and over; Buenos Aires, Argentina; Elderly; Female; Havana, Cuba; Health; Health Care Services; Health Care Utilization; Health Services - statistics & numerical data; Health Services Accessibility - statistics & numerical data; Humans; Income Inequality; Latin America; Male; Mexico City, Mexico; Middle Aged; Montevideo, Uruguay; Santiago, Chile; Sao Paulo, Brazil; Social Inequality; Sociodemographic Factors; Socioeconomic Factors
• ISSN: 1020-4989; 1680-5348
• DOI: 10.1590/S1020-49892005000500013

To learn if there is social inequality in health and in the utilization of health services among the elderly in six cities of Latin America: Buenos Aires, Argentina; São Paulo, Brazil; Santiago, Chile; Havana, Cuba; Mexico City, Mexico; and Montevideo, Uruguay. This study used data from a project called Health, Well-being, and Aging in Latin America and the Caribbean (known as the "SABE project"). To investigate the presence of social inequality in health an ordinal probit model was used, with health status indicated by the following dependent variables: activities of daily living, instrumental activities of daily living, physical mobility, and self-rated health. To measure social inequality in the utilization of health services two characteristics were assessed: one for outpatient medical services (whether or not individuals received outpatient care, and how many times), and one for hospital admissions (whether or not individuals were hospitalized). For outpatient services, we estimated a negative binomial hurdle model, and for hospital admissions, a logit model was constructed. Our main results suggest the presence of social inequality in health in all the cities, with better-off socioeconomic groups having better health. The difference in health was less marked in Havana, Buenos Aires, and Montevideo, and it was more pronounced in São Paulo and Mexico City. With respect to the utilization of health services we found inequalities in the use of outpatient services in Santiago, Mexico City, and São Paulo. In Santiago and Mexico City, more schooling was associated with a higher number of expected outpatient medical visits; however, the opposite was found in São Paulo. For hospital admissions, inequality was found only in São Paulo, with individuals with more years of schooling being much more likely to be hospitalized. To a certain extent, our results reflect the socioeconomic and demographic characteristics of the countries in which each of the six cities is located. The cities in the countries with the worst social indicators (high income inequality and low human development index) tended to have the greatest inequalities in health and in the utilization of health services.