The influence of socioeconomic deprivation, access to healthcare and physical environment on old-age survival in Portugal

Spatial inequalities in old-age survival exist in Portugal and might be associated with factors pertaining to three distinct domains: socioeconomic, physical environmental and healthcare. We evaluated the contribution of these factors on the old-age survival across Portuguese municipalities deriving a surrogate measure of life expectancy, a 10-year survival rate that expresses the proportion of the population aged 75-84 years old who reached 85-94. As covariates we used two internationally comparable multivariate indexes: the European deprivation index and the multiple physical environmental deprivation index. A national index was developed to evaluate the access to healthcare. Smoothed rates and odds ratios (OR) were estimated using Bayesian spatial models. Socioeconomic deprivation was found to be the most relevant factor influencing old-age survival in Portugal [women: least deprived areas OR=1.132(1.064-1.207); men OR=1.044(1.001- 1.094)] and explained a sizable amount of the spatial variance in survival, especially among women. Access to healthcare was associated with old-age survival in the univariable model only; results lost significance after adjustment for socioeconomic circumstances [women: higher access to healthcare OR=1.020(0.973- 1.072); men OR=1.021(0.989-1.060)]. Physical environmental deprivation was unrelated with old-age survival. In conclusion, socioeconomic deprivation was the most important determinant in explaining spatial disparities in old-age survival in Portugal, which indicates that policy makers should direct their efforts to tackle socioeconomic differentials between regions.This work was supported by Portuguese funds through FCT – Fundação para a Ciência e a Tecnologia in the framework of project UID/BIM/04293/2013. AIR would also like to thank to FCT – Fundação para a Ciência e a Tecnologia for the PhD grant SFRH/BD/82529/2011. MSC was supported by CNpQ (309692/2013-0) and FAPERJ (E-26/203.557/2014). The EPIUnit, Institute of Public Health, University of Porto, Portugal (UID/DTP/04750/2013) is funded by the FCT – Fundação para a Ciência e a Tecnologia