Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities

Detalhes bibliográficos
Autor(a) principal: Hone, Thomas
Data de Publicação: 2019
Outros Autores: Mirelman, Andrew J., Rasella, Davide, Sousa, Rômulo Paes, Barreto, Mauricio Lima, Rocha, Rudi, Millett, Christopher
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/39674
Resumo: Imperial College London. School of Public Health. Public Health Policy Evaluation Unit. London, UK.
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spelling Hone, ThomasMirelman, Andrew J.Rasella, DavideSousa, Rômulo PaesBarreto, Mauricio LimaRocha, RudiMillett, Christopher2020-02-03T13:53:00Z2020-02-03T13:53:00Z2019HONE, Thomas et al. Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities. Lancet Global Health, v. 7, p. e1575-1583, 2019.2214-109Xhttps://www.arca.fiocruz.br/handle/icict/3967410.1016/S2214-109X(19)30409-7engElsevierRecessão econômicaDesempregoProgramas de saúdeDespesas em saúdeAumento da MortalidadeProteção socialBrasilEconomic RecessionUnemploymentHealth Programs and PlansHealth ExpendituresMortalitySocial WelfareBrazilEffect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalitiesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleImperial College London. School of Public Health. Public Health Policy Evaluation Unit. London, UK.University of York. Centre for Health Economics. York, UK.Imperial College London. School of Public Health. Public Health Policy Evaluation Unit. London, UK / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, RJ, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brasil.Universidade Federal da Bahia. Instituto da Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.Fundação Getúlio Vargas. Sao Paulo School of Business Administration. São Paulo, SP, Brazil / Instituto de Estudos para Politicas de Saúde. São Paulo, SP, Brasil.Imperial College London. School of Public Health. Public Health Policy Evaluation Unit. London, UK / Instituto de Estudos para Politicas de Saúde. São Paulo, SP, Brasil.Background Economic recession might worsen health in low-income and middle-income countries with precarious job markets and weak social protection systems. Between 2014–16, a major economic crisis occurred in Brazil. We aimed to assess the association between economic recession and adult mortality in Brazil and to ascertain whether health and social welfare programmes in the country had a protective effect against the negative impact of this recession. Methods In this longitudinal analysis, we obtained data from the Brazilian Ministry of Health, the Brazilian Institute for Geography and Statistics, the Ministry of Social Development and Fight Against Hunger, and the Information System for the Public Budget in Health to assess changes in state unemployment level and mortality among adults (aged ≥15 years) in Brazil between 2012 and 2017. Outcomes were municipal all-cause and cause-specific mortality rates for all adults and across population subgroups stratified by age, sex, and race. We used fixed-effect panel regression models with quarterly timepoints to assess the association between recession and changes in mortality. Mortality and unemployment rates were detrended using Hodrick–Prescott filters to assess cyclical variation and control for underlying trends. We tested interactions between unemployment and terciles of municipal social protection and health-care expenditure to assess whether the relationship between unemployment and mortality varied. Findings Between 2012 and 2017, 7 069 242 deaths were recorded among adults (aged ≥15 years) in 5565 municipalities in Brazil. During this time period, the mean crude municipal adult mortality rate increased by 8·0% from 143·1 deaths per 100 000 in 2012 to 154·5 deaths per 100 000 in 2017. An increase in unemployment rate of 1 percentage-point was associated with a 0·50 increase per 100 000 population per rter (95% CI 0·09–0·91) in allcause mortality, mainly due to cancer and cardiovascular disease. Between 2012 and 2017, higher unemployment accounted for 31 415 excess deaths (95% CI 29 698–33 132). All-cause mortality increased among black or mixed race (pardo) Brazilians (a 0·46 increase [95% CI 0·15–0·80]), men (0·67 [0·22–1·13]), and individuals aged 30–59 years (0·43 [0·16–0·69] per 1 percentage-point increase in the unemployment rate. No significant association was identified between unemployment and all-cause mortality for white Brazilian, women, adolescents (aged 15–29 years), or older and retired individuals (aged ≥60 years). In municipalities with high expenditure on health and social protection programmes, no significant increases in recession-related mortality were observed.info:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-82991https://www.arca.fiocruz.br/bitstream/icict/39674/1/license.txt5a560609d32a3863062d77ff32785d58MD51ORIGINALHone T Effect of economic Lancet Global Health.pdfHone T Effect of economic Lancet Global Health.pdfapplication/pdf1986086https://www.arca.fiocruz.br/bitstream/icict/39674/2/Hone%20T%20%20Effect%20of%20economic%20Lancet%20Global%20Health.pdf75b0ba9114e24416590f1953a6a4bee4MD52TEXTHone T Effect of economic Lancet Global Health.pdf.txtHone T Effect of economic Lancet Global Health.pdf.txtExtracted 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dc.title.pt_BR.fl_str_mv Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities
title Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities
spellingShingle Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities
Hone, Thomas
Recessão econômica
Desemprego
Programas de saúde
Despesas em saúde
Aumento da Mortalidade
Proteção social
Brasil
Economic Recession
Unemployment
Health Programs and Plans
Health Expenditures
Mortality
Social Welfare
Brazil
title_short Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities
title_full Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities
title_fullStr Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities
title_full_unstemmed Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities
title_sort Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities
author Hone, Thomas
author_facet Hone, Thomas
Mirelman, Andrew J.
Rasella, Davide
Sousa, Rômulo Paes
Barreto, Mauricio Lima
Rocha, Rudi
Millett, Christopher
author_role author
author2 Mirelman, Andrew J.
Rasella, Davide
Sousa, Rômulo Paes
Barreto, Mauricio Lima
Rocha, Rudi
Millett, Christopher
author2_role author
author
author
author
author
author
dc.contributor.author.fl_str_mv Hone, Thomas
Mirelman, Andrew J.
Rasella, Davide
Sousa, Rômulo Paes
Barreto, Mauricio Lima
Rocha, Rudi
Millett, Christopher
dc.subject.other.pt_BR.fl_str_mv Recessão econômica
Desemprego
Programas de saúde
Despesas em saúde
Aumento da Mortalidade
Proteção social
Brasil
topic Recessão econômica
Desemprego
Programas de saúde
Despesas em saúde
Aumento da Mortalidade
Proteção social
Brasil
Economic Recession
Unemployment
Health Programs and Plans
Health Expenditures
Mortality
Social Welfare
Brazil
dc.subject.en.pt_BR.fl_str_mv Economic Recession
Unemployment
Health Programs and Plans
Health Expenditures
Mortality
Social Welfare
Brazil
description Imperial College London. School of Public Health. Public Health Policy Evaluation Unit. London, UK.
publishDate 2019
dc.date.issued.fl_str_mv 2019
dc.date.accessioned.fl_str_mv 2020-02-03T13:53:00Z
dc.date.available.fl_str_mv 2020-02-03T13:53:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.citation.fl_str_mv HONE, Thomas et al. Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities. Lancet Global Health, v. 7, p. e1575-1583, 2019.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/39674
dc.identifier.issn.pt_BR.fl_str_mv 2214-109X
dc.identifier.doi.pt_BR.fl_str_mv 10.1016/S2214-109X(19)30409-7
identifier_str_mv HONE, Thomas et al. Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities. Lancet Global Health, v. 7, p. e1575-1583, 2019.
2214-109X
10.1016/S2214-109X(19)30409-7
url https://www.arca.fiocruz.br/handle/icict/39674
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
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