Publicação
Health Inequality in Portugal: A four-decade endurance test? Evolution of income-related inequalities in morbidity and health-related behaviours (1987–2019)
| Resumo: | ABSTRACT - Introduction: Equity is a core principle of Portuguese NHS, yet income-related health inequalities persist and have been reported to be among the highest in Europe. To date, however, no comprehensive analysis has systematically examined trends in health inequalities across socioeconomic groups. This study aims to assess the evolution of income-related health inequalities in Portugal (1987-2019), covering indicators of morbidity and health-related behaviours. Methods: Repeated cross-sectional analysis of Portuguese National Health Interview Survey waves (1987, 1995, 1999, 2005/06, 2014, 2019) among adults aged 18-64; a harmonised set of indicators consistently measured across waves was grouped into four domains - subjective (self-assessed health), sociofunctional (functional limitations), medical (diabetes, asthma, chronic bronchitis, hypertension), and behavioural (obesity, tobacco use, physical activity). Household income was equivalised and ranked into wave-specific quintiles; income-related inequalities were estimated using concentration curves and indices with age-sex standardisation. Results: Data analysis shows a persistent and widening gradient, detrimental to poorer income groups, for all outcomes, particularly for self-assessed health and mobility limitations. Over time, inequalities were more stable for medical indicators (diabetes, asthma, chronic bronchitis and hypertension) but tended to increase after 2005. Health-related behaviours diverged in their overall patterns - obesity was concentrated among the poor in all periods with inequality increasing, tobacco use shifted from concentration among the better-off to concentration among the less well-off, and physical activity showed an uneven trend over time concentrated among the better-off. Conclusions: Income-related health inequalities have persisted - and in most domains increased - over the last four decades (1987-2019). Progress to improve this situation requires intersectoral action on social determinants of health and multivariate analyses to identify policy-relevant drivers. |
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| Autores principais: | Correia, Maria Inês Mourato |
| Assunto: | Health inequities Health status disparities Socioeconomic factors Health surveys Portugal Iniquidades em saúde Desigualdades em saúde Fatores socioeconómicos Inquéritos de Saúde |
| Ano: | 2025 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade Nova de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório Institucional da UNL |
| Resumo: | ABSTRACT - Introduction: Equity is a core principle of Portuguese NHS, yet income-related health inequalities persist and have been reported to be among the highest in Europe. To date, however, no comprehensive analysis has systematically examined trends in health inequalities across socioeconomic groups. This study aims to assess the evolution of income-related health inequalities in Portugal (1987-2019), covering indicators of morbidity and health-related behaviours. Methods: Repeated cross-sectional analysis of Portuguese National Health Interview Survey waves (1987, 1995, 1999, 2005/06, 2014, 2019) among adults aged 18-64; a harmonised set of indicators consistently measured across waves was grouped into four domains - subjective (self-assessed health), sociofunctional (functional limitations), medical (diabetes, asthma, chronic bronchitis, hypertension), and behavioural (obesity, tobacco use, physical activity). Household income was equivalised and ranked into wave-specific quintiles; income-related inequalities were estimated using concentration curves and indices with age-sex standardisation. Results: Data analysis shows a persistent and widening gradient, detrimental to poorer income groups, for all outcomes, particularly for self-assessed health and mobility limitations. Over time, inequalities were more stable for medical indicators (diabetes, asthma, chronic bronchitis and hypertension) but tended to increase after 2005. Health-related behaviours diverged in their overall patterns - obesity was concentrated among the poor in all periods with inequality increasing, tobacco use shifted from concentration among the better-off to concentration among the less well-off, and physical activity showed an uneven trend over time concentrated among the better-off. Conclusions: Income-related health inequalities have persisted - and in most domains increased - over the last four decades (1987-2019). Progress to improve this situation requires intersectoral action on social determinants of health and multivariate analyses to identify policy-relevant drivers. |
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