This document compares socioeconomic disparities in health among retirement age adults in Brazil and Mexico. It finds: 1) Both diabetes and hypertension prevalence increased between survey years in both countries, with higher rates in Mexico. 2) In Brazil, women with more education reported lower rates of both conditions, while in Mexico disparities were smaller or reversed. 3) Among men, those with less education in Brazil reported lower hypertension, while in Mexico measured rates were higher for less educated men. 4) Self-reported data may underestimate disparities, as access to healthcare likely varies by socioeconomic status. Measured data showed larger disparities in Mexico.

1. ASSESSMENT OFTHE IMPACT OF
SOCIOECONOMIC DISPARITIES IN HEALTH
AMONG RETIREMENT AGE ADULTS IN
BRAZIL AND MEXICO
Flavia C. D. Andrade
University of Illinois at Urbana-Champaign,USA
Mariana López-Ortega
Instituto Nacional de Geriatría, Mexico

2. Background
• Brazil and Mexico have the largest populations of older adults in Latin
America.
• 2015: 16.5 million(8%) in Brazil and 8.2 million people (6.5%) in Mexico
[1].
• Both countries also have experienced large gains in life expectancy in
recent decades.
• Life expectancy at birth in 2010-2015: 74 in Brazil and 77.5 in Mexico.

3. Background
• The increase in the proportion of older adults living longer has affected
both public health care costs and pension systems in both countries.
• As a result, the issue of extending working life became an important policy
issue given the population aging.

6. Retirement
BRAZIL
• Retirement age remains relatively low and no universal minimum age is imposed [2].
• Average age at retirement on time at contribution was 54.4 for men and 51.3 for women
– as a result, a man who retires receives his pension for an average 23.0 years and a
woman for 29.2 years [3].
• About 7.2% of the Brazilian gross domestic product (GDP) is used to pay for retirement
benefits.
MEXICO
• In 2013, only 26.1% adults 60 years and over—35 per cent for men and 18.5 per cent for
women [9]—had a retirement pension.
• The public and private expenditure on pension benefits is approximately 1.8 percent of
GDP [8].

7. Brazil

8. Mexico

9. Objective
• Compare educational and sex differences in the health (i.e. diabetes and
hypertension) among adults 50-74.
• We use estimates from nationally representative samples in Brazil and Mexico to
evaluate how the adoption of homogenous policies may differently influence
social groups.

10. Data
• Brazil
• Brazilian National Household Survey (PNAD) 2003
• National Health Survey (PNS) 2013.
• Mexico
• Mexican National Health Survey (ENSA) 2000
• National Health and Nutrition Survey (ENSANUT) 2012

11. Methods
• Descriptive statistics are provided by age, sex and period.
• Logistic regressions
• Locally-weighted scatterplot smoother (LOWESS)
• Main variables: age, sex, educational levels, self-reported diabetes and
hypertension
 Education
 No education - no education or less than one year of formal schooling;
 Primary- one to six years of completed formal education
 More than primary - seven or more years of schooling

12. Brazil Mexico
2003 2013 2000 2012
Health conditions
Diabetes 10.0 14.5 16.8 22.0
Hypertension 40.8 42.0 30.8 31.1
Education
No education 26.5 21.4 5.4 13.9
Primary 48.0 45.8 69.3 49.3
More than primary 25.5 32.8 25.3 36.8
Sex
Male 46.0 46.1 50.0 47.6
Female 54.0 53.9 50.0 52.4
Age groups
50-54 30.2 28.6 32.5 31.2
55-59 23.6 26.0 24.0 26.2
60-64 19.2 19.4 19.8 18.0
65-69 15.1 14.9 13.8 13.4
70-74 12.0 11.1 9.9 11.1
Sample size 57300 17320 8888 13020
Table 1. Descriptive statistics by year, Brazil and Mexico (weighted estimates)

13. Table 3. Estimates of logistic regressions on the association between self-reported diabetes, hypertension and
socioeconomic status. Brazil and Mexico
Brazil Mexico
VARIABLES OR OR
Diabetes
Education (ref=no education)
Primary 1.07** 1.16***
More than primary 0.86*** 1.04
Age 1.04*** 1.03***
Female (ref=Male) 1.38*** 1.33***
Most recent (ref=least recent) 1.50*** 1.37***
Constant 0.01*** 0.03***
Observations 73,443 21,778
Hypertension
Education (ref=no education)
Primary 1.03* 1.39***
More than primary 0.79*** 1.40***
Age 1.04*** 1.04***
Female (ref=Male) 1.76*** 2.02***
Most recent (ref=least recent) 1.00 1.05
Constant 0.04*** 0.02***
Observations 74,378 20,995

14. Graph 1. Diabetes among Adult Women in Brazil (2013) and Mexico (2012)
Brazil
0
.1.2.3.4
Diabetes
50 55 60 65 70 75
Age in years
No education Primary
More than primary
Mexico
0
.1.2.3.4
50 55 60 65 70 75
age in years
No education Primary
More than primary

15. Graph 2. Diabetes among Adult Men in Brazil (2013) and Mexico (2012)
Brazil0
.1.2.3.4
Diabetes
50 55 60 65 70 75
Age in years
No education Primary
More than primary
Mexico
0
.1.2.3.4
50 55 60 65 70 75
age in years
No education Primary
More than primary

16. Graph 3. Hypertension among Adult Women in Brazil (2013) and Mexico (2012)
Brazil
.1.2.3.4.5.6
Hypertension
50 55 60 65 70 75
Age in years
No education Primary
More than primary
Mexico
.1.2.3.4.5.6
50 55 60 65 70 75
age in years
No education Primary
More than primary

17. Graph 4. Hypertension among Adult Men in Brazil (2013) and Mexico (2012)
Brazil
.1.2.3.4.5.6
Hypertension
50 55 60 65 70 75
Age in years
No education Primary
More than primary
Mexico
.1.2.3.4.5.6
50 55 60 65 70 75
age in years
No education Primary
More than primary

18. Diabetes
0
.2.4.6
50 55 60 65 70 75
Age in years
Hypertension
0
.2.4.6
50 55 60 65 70 75
Age in years
No education Primary
More than primary
Poor health
0
.2.4.6
50 55 60 65 70 75
Age in years
Graph 5. Health conditions among Adult Women in Brazil (2013)

19. Diabetes
0
.1.2.3.4.5
50 55 60 65 70 75
Age in years
Hypertension
0
.1.2.3.4.5
50 55 60 65 70 75
Age in years
Poor health
0
.1.2.3.4.5
50 55 60 65 70 75
Age in years
No education Primary
More than primary
Graph 6. Health conditions among Adult Men in Brazil (2013)

20. 0
.2.4.6.8
Diabetes
50 55 60 65 70 75
0
.2.4.6.8
Hypertension
50 55 60 65 70 75
0
.2.4.6.8
Poor health
50 55 60 65 70 75
No educ
Primary
More than primary
0
.2.4.6.8
ADL
50 55 60 65 70 75
Graph 8. Health conditions among Adult Women in Mexico, MHAS (2015)

21. 0
.1.2.3.4.5
Diabetes
50 55 60 65 70 75
0
.1.2.3.4.5
Hypertension
50 55 60 65 70 75
0
.1.2.3.4.5
Poor health
50 55 60 65 70 75
No educ
Primary
More than primary
0
.1.2.3.4.5
ADL
50 55 60 65 70 75
Graph 8. Health conditions among Adult Men in Mexico, MHAS (2015)

22. Discussion
• For Mexico the possible mediating effect of SES on access to health services and detection
of chronic diseases should be explored in the future as there are important differences in
prevalence by self-report vs. measurements, for example in hypertension self-report vs.
blood pressure measured at the time of the survey.
Percentage of adults with hypertension, by sex and age group. ENSANUT 2012
Source: Gutierrez et al., 2013
22.3
33.5 31.0
39.3
21.8
25.8 28.8
21.2
50-59 60-69 70-79 80+
Men
Self-reported % Detected %
29.4
47.1
43.1
35.8
18.0
14.8 22.7
15.8
50-59 60-69 70-79 80+
Women
Self-reported % Detected %

23. Graph 9. Self-reported and Measured Hypertension among Adult Women in Mexico, ENSANUT (2012)
Self-reported
.2.3.4.5.6
50 55 60 65 70 75
age in years
No education Primary
More than primary
Measured
.2.3.4.5.6
50 55 60 65 70 75
age in number of years

24. Graph 10. Self-reported and Measured Hypertension among Adult Men in Mexico, ENSANUT (2012)
Self-reported
.1.2.3.4.5
50 55 60 65 70 75
No education Primary
More than primary
Measured
.1.2.3.4.5
50 55 60 65 70 75

25. Discussion
• Important social gradients
• Women with more education were less likely to report having
diabetes in Brazil and Mexico
• However, among men self-reported diabetes was more reported
among those with more education (even though for more recent
cohorts, the situation seems to be changing)

26. Discussion
• In Brazil, women with more education reported lower prevalence of hypertension
than those with less education, but the reverse was found in Mexico based on self-
reported data.When analyzing blood pressure measurements, similar levels were
found among women with no education and more than primary.
• Among men, those with less education reported lower prevalence of
hypertension. In contrast, less educated men have higher prevalence of
hypertension when using measured blood pressure.

27. Limitations
• Self-reported data that implies individuals have had access to health care services,
while such access can also have important SES gradients.
• Focus only on diabetes and hypertension
• Need to incorporate other health conditions (e.g. disability, mobility, SHR)
• Urban/rural differences
• Occupational differences

28. Thanks

29. Wording
Brazil
• 2003“...have [health condition]?”
• “Has a doctor has given you a
diagnosis of [health condition]?
Mexico
• 2000 and 2012: “Has a physician
told you have (health condition)”?

30. (Rocha and Caetano 2008)

31. (Rofman, Lucchetti et al.)

32. (Rofman, Lucchetti et al.)

33. (Rofman, Lucchetti et al.)

34. Beltran-Sanchez &Andrade (forthcoming)

35. Beltran-Sanchez &Andrade (forthcoming)

36. Brazil Mexico Mexico MHAS
VARIABLES OR se OR se OR se
Diabetes
Education (ref=no education) .
Primary 1.07** 0.03 1.16*** 0.06 1.10 0.07
More than primary 0.86*** 0.03 1.04 0.06 0.88 0.06
Age 1.04*** 0.00 1.03*** 0.00 1.02*** 0.00
Female (ref=Male) 1.38*** 0.03 1.33*** 0.05 1.37*** 0.06
Year 2013 (ref=2003) 1.50*** 0.04 1.37*** 0.05
Constant 0.01*** 0.00 0.03*** 0.01 0.06*** 0.02
Observations 73,443 21,778 10491
Hypertension
Education (ref=no education)
Primary 1.03* 0.02 1.39*** 0.07 1.14** 0.07
More than primary 0.79*** 0.02 1.40*** 0.08 1.01 0.07
Age 1.04*** 0.00 1.04*** 0.00 1.05*** 0.00
Female (ref=Male) 1.76*** 0.03 2.02*** 0.06 1.79*** 0.07
Most recent year (ref=least recent) 1.00 0.02 1.05 0.03
Constant 0.04*** 0.00 0.02*** 0.00 0.02*** 0.01
Observations 74,378 20,995 10493