RESUMO
Mean AIDS incidence rates were calculated for three time periods, 1987-89, 1990-92, and 1993-96, using reported adult AIDS cases by county. The analysis included the following variables: "population of counties for resident AIDS cases"; "proportion of population residing in urban areas", and "concentration of poverty", stratifying by gender and exposure categories. The Southeast region has experienced the lowest increase, contrasting with the steep rise observed in the North and South between the second and third study periods. Comparing variations in incidence rates from 1990-92 and 1993-96 by region or population, the greatest increase was among women. In the larger cities, AIDS cases among "homo/bisexual men" predominate, although the proportion of cases among men who have sex with men has decreased as heterosexual cases have undergone a continuous increase. IDUs have been the core stratum in medium-sized counties. For the smallest counties, heterosexual transmission has been the basic element in local dynamics. Even though AIDS is still an urban phenomenon in Brazil, the epidemic is spreading to rural counties. Until recently it has mainly affecting relatively more affluent areas, but there is now an evident spread of the epidemic to poorer areas.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Surtos de Doenças , Características de Residência , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Brasil/epidemiologia , Notificação de Doenças , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
OBJECTIVES: This study determined the effect of income inequality on homicide rates in the state of Rio de Janeiro, Brazil. METHODS: We conducted an ecological study at 2 geographical levels, municipalities in the state of Rio de Janeiro and administrative regions in the municipality of Rio de Janeiro. The association between homicide and income inequality was tested by multiple regression procedures, with adjustment for other socioeconomic indicators. RESULTS: For the municipalities of Rio de Janeiro State, no association between homicide and income concentration was found an outcome that can be explained by the municipalities' different degrees of urbanization. However, for the administrative regions in the city of Rio de Janeiro, the 2 income inequality indicators were strongly correlated with the outcome variable (P < .01). Higher homicide rates were found precisely in the sector of the city that has the greatest concentration of slum residents and the highest degree of income inequality. CONCLUSIONS: The findings suggest that social policies specifically aimed at low-income urban youth, particularly programs to reduce the harmful effects of relative deprivation, may have an important impact on the homicide rate.
Assuntos
Homicídio/estatística & dados numéricos , Renda/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Saúde da População Urbana , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Escolaridade , Feminino , Homicídio/prevenção & controle , Humanos , Masculino , Análise Multivariada , Densidade Demográfica , Vigilância da População , Pobreza/prevenção & controle , Análise de Regressão , Características de Residência/estatística & dados numéricos , Distribuição por Sexo , UrbanizaçãoRESUMO
This ecological analysis addresses the association between income inequality and health status in the municipality of Rio de Janeiro. Data were analyzed using geo-processing and multiple regression techniques. The following health indicators were used: infant mortality rate; standardized mortality rate; life expectancy at birth; and homicide rate among 15-29-year-old males. Patterns of income inequality were assessed through income distribution indicators: Gini index, Robin Hood index, and top 10 %/bottom 40% average income ratio. The results indicate significant correlations between income distribution indicators and health indicators, providing additional empirical evidence of the association between health status and income inequality. For the homicide rate, the effect of the indicator "density of slum residents" was also relevant, suggesting that further deterioration in health standards may be due to social disruption of deprived communities and the resultant increase in criminal activity. The geo-epidemiological analysis presented here highlights the association between adverse health outcomes and residential concentration of poverty. Social policies focused on slum residents are needed to reduce the harmful effects of relative deprivation.