1. Non-Communicable Diseases and Inequality in Latin America: Some Evidence for cardiovascular diseases in Brazil Andre Medici World Bank (LCSHH) Kaizo Beltrao Getulio Vargas Foundation (Brazil) Washington (DC) June 24, 2013

2. Introduction  NCDs are an increasing challenge for equity in LAC.  NCDs are associated with behavioral changes and risk factors. They start in higher income groups and progressively are extended to the poor along the demographic transition process;  Along the epidemiological transition, the big challenge for the poor is the inequality on the access to early diagnostic and treatment, preventing the poor to have information about their NCD problems.  Household surveys data could reflect asymmetric information about individual health conditions associated with the income level.  Its lead the poor to under-declare their NCD condition, especially when they are asked to present some medical diagnostic that support it.  The objective of this presentation is to evaluate data on NCDs declared prevalence by income level using data from household surveys.

3. Methodology and variables  This presentation will illustrate the case of cardiovascular disease using data from the Brazilian household surveys (PNADs 2003 and 2008);  The special supplement of the PNADs 2003 and 2008 investigate the prevalence of eight chronic conditions and risk factors. The NCDs declared prevalence should be proved by presenting a doctor prescription or medical record;  The data was age-standardized by a model;  Attribute variables are gender, age and ethnicity (declared color), as a way to explain socioeconomic and demographic differences associated with the cardiovascular disease prevalence by income;  The data allows to evaluate the progressivity level of the cardiovascular disease prevalence. In this case, if the prevalence is progressive, it means that it is affecting the rich more than the poor, and vice-versa. The level of prevalence should be measured by the Gini coefficient;  If the Gini Coefficient is negative, than the prevalence is regressive. It has been found for some NCDs investigated in Brazil.

4. NCDs and Risk Factors Surveyed NCD’sRISK FACTORS Back Pain Arthritis and Rheumatism Cancer Diabetes Bronchitis and Asthma Hypertension Heart Disease Diet Physical Inactivity Tobacco

5. Cardiovascular diseases: Inequality according gender (1)

6. Cardiovascular diseases: Inequality according gender (2)

8. Inequality According Age and Color

9. Comments on Equity and Cardiovascular Diseases in Brazil (1)  Cardiovascular diseases prevalence rate is higher for women than men in all income quintiles in 2008. The gaps on prevalence rates between men and women increase from the poorest to the third income quintile and reduce from the third to the richest quintile.  This situation could reflect a worse access for cardiovascular disease diagnostic and treatment for men, which could be associated with behavior and labor conditions. For the richest quintile gaps are not expressive;  From 2003 to 2008, female cardiovascular disease prevalence reduced, meanwhile it increased among men in all income quintiles.  Cardiovascular disease prevalence is progressive, as can be seen by the Gini coefficient.  The concentration levels of prevalence are higher form men than for women. It also could be explained by the hypothesis that women had more information about her medical conditions than men and visit more often doctors.

10. Comments on Equity and Cardiovascular Diseases in Brazil (2)  However, for both men and women cardiovascular diseases prevalence rates concentration had been reduced between 2003 and 2008, indicating no significant prevalence differences in cardiovascular diseases in the near future. Otherwise, it could mean increased access to diagnostic for the poorest income quintiles.  Aging is a severe factor associated with increase prevalence of cardiovascular diseases in all income quintiles. In 2008, prevalence rates for the age group 60 and more years is three to four times bigger than in the age group 15-60 years.  Prevalence gaps on cardiovascular diseases among men and women increase from the poorest to third/fourth quintile and reduced in the richest one in the old age group (60 years and more).  The same does not happen with the economic active age group (15-60) where the gap is progressively reduced from the poorest to the richest quintile

11. Comments on Equity and Cardiovascular Diseases in Brazil (3)  Highest prevalence of cardiovascular diseases could be found among the African-Brazilian population in the poorest and the richest income quintiles, and among the white population from the second to the fourth income quintiles.  The prevalence for African-Brazilian population fluctuated up and down two times from the poorest to the rich quintiles. It could reflect a rapid economic progress of this group during the past decade.  To the self-declared pardo population (which constitute the majority of the Brazilian population), the cardiovascular disease prevalence increase constantly from the poorest to the riches income quintile.

12. THANKS amedici@worldbank.org