Health conditions and residential concentration of poverty: a study in Riode Janeiro, Brazil

Study objectives-To establish the geographical relation of health condition s to socioeconomic status in the city of Rio de Janeiro, Brazil. Design-All reported deaths in the municipality of Rio de Janeiro, from 1987 to 1995, obtained from the Mortality Information System, were considered i n the study. The 24 "administrative regions" that compose the city were use d as the geographical units. A geographical information sg stem (GIS) was u sed to link mortality data and population census data, and allowed the auth ors to establish the geographical pattern of the health indicators consider ed in this study: "infant mortality rate"; "standardised mortality rate"; " life expectancy" and "homicide rate". Information on location of low income communities (slums) was also provided by the GIS. A varimax rotation princ ipal component analysis combined information on socioeconomic conditions an d provided a two dimension basis to assess contextual variation. Main results-The 24 administrative regions were aggregated into three diffe rent clusters, identified as relevant to reflect the socioeconomic variatio n. Almost all health indicator thematic maps showed the same socioeconomic stratification pattern. The worst health situation was found in the cluster composed of the harbour area and northern vicinity, precisely in the secto r where the highest concentration of slum residents are present. This secto r of the city exhibited an extremely high homicide rate and a seven year lo wer Life expectancy than the remainder of the city. The sector that concent rates affluence, composed of the geographical units located along the coast , showed the best health situation. Intermediate health conditions were fou nd in the west area, which also has poor living standards but low concentra tion of slums. Conclusions-The findings suggest that social and organisation characteristi cs of low income communities may have a relevant role in understanding heal th variations. Local health and other social programmes specifically target ing these communities are recommended.