RESUMEN
ABSTRACT Objective: To estimate the prevalence of adult smokers in the 26 capitals and the Federal District according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP). Methods: Dataset on smoking were obtained from the Surveillance of Risk and Protective Factors for Noncommunicable Diseases by Survey (Vigitel) system for the 26 capitals and the Federal District, in the period from 2010 to 2013. The IBP classifies the census sectors according to indicators such as: income less than ½ minimum wage, illiterate population and without sanitary sewage. In the North and Northeast regions, the census sectors were grouped into four categories (low, medium, high and very high deprivation) and in the South, Southeast and Midwest regions into three (low, medium and high deprivation). Prevalence estimates of adult smokers were obtained using the indirect estimation method in small areas. To calculate the prevalence ratios, Poisson models are used. Results: The positive association between prevalence and deprivation of census sector categories was found in 16 (59.3%) of the 27 cities. In nine (33.3%) cities, the sectors with the greatest deprivation had a higher prevalence of smokers when compared to those with the least deprivation, and in two (7.4%) there were no differences. In Aracaju, Belém, Fortaleza, João Pessoa, Macapá and Salvador, the prevalence of adult smokers was three times higher in the group of sectors with greater deprivation compared to those with less deprivation. Conclusion: Sectors with greater social deprivation had a higher prevalence of smoking, compared with less deprivation, pointing to social inequalities.
RESUMO Objetivo: Estimar as prevalências de adultos fumante nas 26 capitais e no Distrito Federal segundo o Índice Brasileiro de Privação. Métodos: Os dados sobre tabagismo foram obtidos junto ao sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito (Vigitel) para as 26 capitais e o Distrito Federal, no período de 2010 a 2013. O Índice Brasileiro de Privação classifica os setores censitários segundo indicadores como: renda menor que meio salário mínimo, população não alfabetizada e sem esgotamento sanitário. Nas regiões Norte e Nordeste, os setores censitários foram agrupados em quatro categorias (baixa, média, alta e muito alta privação) e, nas regiões Sul, Sudeste e Centro-Oeste, em três (baixa, média e alta privação). As estimativas de prevalências de adultos fumantes foram obtidas pelo método indireto de estimação em pequenas áreas. Para o cálculo das razões de prevalências, empregram-se modelos de Poisson. Resultados: A associação positiva entre a prevalência e a privação das categorias de setores censitários foi encontrada em 16 (59,3%) das 27 cidades. Em nove (33,3%) cidades, os setores de maior privação apresentaram maior prevalência de fumantes quando comparados aos de menor privação e, em duas (7,4%), não apresentaram diferenças. Em Aracaju, Belém, Fortaleza, João Pessoa, Macapá e Salvador, as prevalências de adultos fumantes foram três vezes maiores no grupo de setores com maior privação em relação aos de menor privação. Conclusão: Setores de maior privação social apresentaram maiores prevalências de tabagismo, comparados com menor privação, apontando desigualdades sociais.
RESUMEN
ABSTRACT OBJECTIVE To describe and assess currently used area-based measures of deprivation in Brazil for health research, to the purpose of informing the development of a future small area deprivation index. METHODS We searched five electronic databases and seven websites of Brazilian research institutions and governmental agencies. Inclusion criteria were: studies proposing measures of deprivation for small areas (i.e., finer geography than country-level) in Brazil, published in English, Portuguese or Spanish. After data-extraction, results were tabulated according to the area level the deprivation measure was created for and to the dimensions of deprivation or poverty included in the measures. A narrative synthesis approach was used to summarize the measures available, highlighting their utility for public health research. RESULTS A total of 7,199 records were retrieved, 126 full-text articles were assessed after inclusion criteria and a final list of 30 articles was selected. No small-area deprivation measures that have been applied to the whole of Brazil were found. Existing measures were mainly used to study infectious and parasitic diseases. Few studies used the measures to assess inequalities in mortality and no studies used the deprivation measure to evaluate the impact of social programs. CONCLUSIONS No up-to-date small area-based deprivation measure in Brazil covers the whole country. There is a need to develop such an index for Brazil to measure and monitor inequalities in health and mortality, particularly to assess progress in Brazil against the Sustainable Development Goal targets for different health outcomes, showing progress by socioeconomic groups.