Desigualdade social, interseccionalidade e hipertensão no Brasil contemporâneo

Abstract

This thesis presents two main studies that provide a series of critical appraisal for the situational analysis of health inequalities. The first one describes a systematic scoping review on the academic production and the estimation methods related to two summary measures of the socioeconomic gradient in health: relative index of inequality (RII) and slope index of inequality (SII). A total of 417 articles used the RII or the SII in original research, published in 136 journals between 1985 and 2016, in which 45% resulted of international collaboration among 1267 researchers from institutions of 60 countries. 51% of the articles used the RII, 13% the SII and 36% both measures. The trend of using both relative and absolute measures prevailed in the most recent literature, reaching 58% of articles published in 2016. I discuss five central proposals for the definition of inequality indices, which were identified by a descriptive indicator, elaborated in this thesis – the number of methodological internal citations. The second one presents a cross-sectional study with data obtained from the National Health Survey (2013), where the RII and the SII were applied for the measurement of inequalities in the prevalence of hypertension in Brazil, according to intersectional strata of gender, race, and education. The age-adjusted prevalence of hypertension was 34% among men and 31% among women, but gender inequality was evident only among white or brown people with high school education or higher. Racial differences in the prevalence of hypertension were observed only among women, and this racial inequality increased with education level. The educational gradient in hypertension was restricted to women self-identified as white (RII = 2.5; SII = 18%) or brown (RII = 2.3, SII = 14.5%), whereas the prevalence of hypertension was homogeneous across educational subgroups among black women and among men of all racial strata. These results show a number of contrasting details for the established social patterning of hypertension, and highlight the importance of examining reciprocity among multiple social dimensions in health inequalities research. The use of the relative index of inequality and the slope index of inequality should be encouraged for health inequalities monitoring in an intersectional perspective.