Socioeconomic inequalities in activities of daily living limitations and in the provision of informal and formal care for noninstitutionalized older Brazilians: National Health Survey, 2013

Ma Fernanda Lima-Costa, Juliana V.M. Mambrini, Sérgio V. Peixoto, Deborah C. Malta, James Macinko

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Background: This study assesses the association between socioeconomic factors and living arrangements with activity of daily living limitations (ADL) and the receipt of informal and formal care among non-institutionalized Brazilians aged ≥ 60 years. Methods: Data come from a nationally representative survey (the Brazilian National Health Survey), conducted in 2013. Outcomes examined include the number of ADL tasks performed with limitations and number of tasks for which the individual received informal care (provided by unpaid relatives or friends), formal care, or no care. Key exposure variables were years of education and household assets. Results: Functioning limitations were reported by 7,233 (30.1 %) of 23,815 survey participants. Of these, 5,978 reported needing help to perform at least one ADL task. There was a strong inverse gradient between physical functioning and both education and household assets that was independent of confounders. The provision of care showed an opposite trend, with the wealthiest being more likely to receive help for performing ADL tasks. The receipt of formal care was strongly correlated with highest education (Fully adjusted prevalence ratio [PR] = 1.64; 95 % CI 1.05, 2.58) and with the highest assets level (PR = 2.24; 95 % CI 1.38, 3.64). Living with someone else was associated with provision of care (formal or informal) for those at the lowest and intermediate educational and assets levels, but not for the wealthiest. Conclusion: Despite worse physical functioning, older Brazilians in worse socioeconomic conditions are much less likely to receive needed help in performing ADL tasks.

Original languageEnglish (US)
Article number137
JournalInternational Journal for Equity in Health
Issue number1
StatePublished - Nov 17 2016



  • Activities of daily living
  • Formal care
  • Functional limitation
  • Informal care
  • Instrumental activities of daily living
  • National health survey
  • Social inequalities
  • Socioeconomic position

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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