Expectativa de vida ao nascer e mortalidade no Brasil em 1999: Ańlise exploratória dos diferenciais regionais

Objective. To analyze the inequalities found using health indicators in the states and regions of Brazil, according to 1999 socioeconomic and demographic indicators. Methods. An exploratory ecological cross-sectional study was carried out. The units of analysis were Brazilian states (n = 27) and regions (n = 5). Descriptive measures of inequality were calculated. Pearson's correlation and also linear regression analysis were used to identify associations between health indicators and selected socioeconomic and demographic indicators. The health indicators analyzed were: life expectancy at birth, infant mortality rate, mortality rate for children < 5 years due to acute diarrheal diseases and to acute respiratory infections, and deaths due to homicides and traffic accidents. Results. Important gains were seen in life expectancy at birth over the 1991-1999 period, especially for males. There was a trend towards larger gains in states that had had lower life expectancy at birth in 1991, which produced greater homogeneity across Brazil in this indicator in recent years. The infant mortality rate decreased by 28% between 1991 and 1999. However, this indicator still varies widely among the regions - from 52.5 per 1000 live births in the northeast to 17.1 per 1000 in the south and among states - from 64.0 per 1000 in Alagoas to 15.1 per 1000 in Rio Grande do Sul. With respect to children < 5 years, the mortality rate due to acute diarrheal diseases was equal to or higher than the national median (4.1 per 10 000) in all the northeastern states, and the mortality rate due to acute respiratory infections was equal to or higher than the national median (10.8 per 10 000) in all the southern, southeastern, and central-western states. The mortality rates (standardized by sex and age) due to traffic accidents and to homicides in 1999 were 17.7 and 26.0 per 100 000 inhabitants, respectively. Extreme values were found in some states for mortality due to homicide (57.8 per 100 000 in Pernambuco) and traffic accidents (54.5 per 100 000 in Roraima). The mortality rate due to homicide was strongly associated with urbanization (P = 0.001). Higher mortality rates due to traffic accidents were associated with lower poverty levels (β = -0.93; P < 0.001), lower literacy rates (β = -1.16; P = 0.005), and larger population growth over the past decade (β = 3.10; P = 0.016). Conclusions. The pattern of health inequality in Brazil indicates a polarization among regions and states as well as a juxtaposition of diseases associated with underdevelopment and diseases linked to development, suggesting the need for a health system that is committed to addressing these issues.