Cause-specific mortality and income inequality in São Paulo, Brazil

Rev Saude Publica. 2012 Aug;46(4):712-8. doi: 10.1590/s0034-89102012005000039. Epub 2012 Jun 19.


Objective: To analyze cause-specific mortality rates according to the relative income hypothesis.

Methods: All 96 administrative areas of the city of São Paulo, southeastern Brazil, were divided into two groups based on the Gini coefficient of income inequality: high (≥0.25) and low (<0.25). The propensity score matching method was applied to control for confounders associated with socioeconomic differences among areas.

Results: The difference between high and low income inequality areas was statistically significant for homicide (8.57 per 10,000; 95%CI: 2.60;14.53); ischemic heart disease (5.47 per 10,000 [95%CI 0.76;10.17]); HIV/AIDS (3.58 per 10,000 [95%CI 0.58;6.57]); and respiratory diseases (3.56 per 10,000 [95%CI 0.18;6.94]). The ten most common causes of death accounted for 72.30% of the mortality difference. Infant mortality also had significantly higher age-adjusted rates in high inequality areas (2.80 per 10,000 [95%CI 0.86;4.74]), as well as among males (27.37 per 10,000 [95%CI 6.19;48.55]) and females (15.07 per 10,000 [95%CI 3.65;26.48]).

Conclusions: The study results support the relative income hypothesis. After propensity score matching cause-specific mortality rates was higher in more unequal areas. Studies on income inequality in smaller areas should take proper accounting of heterogeneity of social and demographic characteristics.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Brazil
  • Cause of Death*
  • Child
  • Female
  • Health Status Disparities*
  • Homicide / statistics & numerical data
  • Humans
  • Income / statistics & numerical data*
  • Male
  • Middle Aged
  • Poverty
  • Propensity Score
  • Social Class
  • Urban Population
  • Young Adult