Adult mortality by education level in São Paulo: comparative analysis based on different methodological strategies

Ribeiro, Mirian Martins; Turra, Cassio Maldonado; Pinto, Cristine Campos de Xavier

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Revista Brasileira de Estudos de População

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ORIGINAL ARTICLE • Rev. bras. estud. popul. 38 • 2021 • https://doi.org/10.20947/S0102-3098a0139 copy

Adult mortality by education level in São Paulo: comparative analysis based on different methodological strategies

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

In this article, we estimate adult mortality by education level in São Paulo. We compare estimates based on deaths from the 2010 Census and the 2013 Mortality Information System (Sistema de Informação de Mortalidade – SIM) – DATASUS, and three different ways of measuring education level: recorded in the SIM, reported in the census for the household heads and imputed statistically in the census for individuals who died. For the statistical imputation, we use the Dempester (1977) method, which proposes using the expectation-maximization algorithm (EM algorithm) to deal with missing data. We consider three education levels (low, medium, and high) and estimate mortality rates based on Poisson models. The results indicate that between ages 25 and 59, more years of schooling are associated with mortality rates up to 77% lower. Secondary (medium) education level provides most of the mortality gains at adult ages (about 50%). The mortality differentials calculated with death records from the SIM and census deaths with education imputed statistically are similar. However, estimates based on the assumption that the deceased's education is equal to the household head's in the census resulted in atypical mortality patterns. We hope that the imputation model we propose in the current study can be used in future mortality analyses by SES using census deaths.

Key words
Adult mortality; Missing data; Imputation; Socioeconomic differentials in mortality; Brazil; Education level

Level/classification	School/description	Measure/grouping
Dependent variable	Education level	Years of study
Deceased individual	Age group	25-29 years
		30-34 years
		35-39 years
		40-44 years
		45-49 years
		50-54 years
		55-59 years
	Sex	1 if man, 0 if woman
Characteristics of household heads	Sex of household heads	1 if man, 0 if woman
	Education level of household heads	Years of study
	Age of household heads	<30 years
		30-39 years
		40-49 years
		50-59 years
		>=60
	Marital status of household heads	1 if they have a spouse, 0 if not
	Does the household head have at least one major disability?	1 if yes, 0 if not
	Race/ethnic group of household head	White
		Black
		Asian
		Brown
		Indigenous
	Difference between the age group of household head and the individual (adult aged between 25 and 59 years)	Difference > - 10 & < 10 years
		Household head is 10 to 19 years younger
		Household head is 20 years or more than 20 years younger than the individual
		Household head is10 to 19 years older
		Household head is 20 years or more than 20 years older than the individual
Household	Indicator of socioeconomic status of household composed of the variables:	4 categories – quartiles
	- presence of tv to in the household
	- presence of a car in the household
	- presence of motorcycle in the household
	- presence of washing machine in the household
	- presence of refrigerator in the household
	- presence of running water in at least 1 room
	- presence of a computer with internet in the household
	- presence of mobile phone in the household
	- predominant permanent material (masonry)
	- if the house is adequate (having water supply through a general network, sewerage through a general network or septic tank, direct or indirect garbage collection, and a maximum of two residents per bedroom)
	- at least 1 resident of the household is a beneficiary of an income transfer program (bolsa família; PETI or other)
	Dependency ratio (<14 or > 60)/(>15 and <59)	1 if >1, 0 if <1
	Occurrence of infant death in the household	1 if yes, 0 if not
	Households composed exclusively of foreigners or naturalized individuals or include Brazilian natives?	1 if include any Brazilian native; 0 if is composed of only foreigners or naturalized individuals
Community	Proportion (%) of people living in subnormal areas within the weighted area	None
		<50
		>50 and < 90
		>90
	Metropolitan area	1 if yes, 0 if not
	Location of household	1 if urban, 0 if rural
	Education level (educc) of a randomly Selected individual (bootstrap sampling)

Sex	Census – sample		Census – weighted sample	SIM	SIM/Census ratio
Sex	CMR	CI (95%)	CMR	CMR	SIM/Census ratio
Women	1.69	[1.50 ; 1.92]	1.70	2.01	1.18
Men	3.79	[3.47 ; 4.14]	3.82	4.35	1.14
Total	2.68	[2.50 ; 2.88]	2.70	3.11	1.15

Age	Men						Women
Age	Low	Medium	High	Total	N	Weighted sample	Low	Medium	High	Total	N	Weighted sample
Education of household heads, deaths from the 2010 Census
25-34	57.1	33.3	9.5	100.0	42	897	41.2	52.9	5.9	100.0	17	335
30-34	42.1	55.3	2.6	100.0	38	754	33.3	38.9	27.8	100.0	18	358
35-39	55.1	32.7	12.2	100.0	49	1,030	35.7	64.3	0.0	100.0	14	293
40-44	54.3	38.6	7.1	100.0	70	1,466	31.3	50.0	18.8	100.0	32	642
45-49	52.1	38.0	9.9	100.0	71	1,514	45.7	41.3	13.0	100.0	46	932
50-54	50.5	40.2	9.3	100.0	107	2,205	43.3	45.0	11.7	100.0	60	1,269
55-59	43.3	39.2	17.5	100.0	120	2,536	41.3	38.1	20.6	100.0	63	1,286
Total	49.9	39.2	10.9	100.0	497	10,403	40.4	44.4	15.2	100.0	250	5,115
Education statistically imputed, deaths from the 2010 Census
25-34	33.3	33.3	33.3	100.0	42	897	17.6	41.2	41.2	100.0	17	335
30-34	44.7	34.2	21.1	100.0	38	754	27.8	44.4	27.8	100.0	18	358
35-39	51.0	28.6	20.4	100.0	49	1,030	64.3	7.1	28.6	100.0	14	293
40-44	58.6	30.0	11.4	100.0	70	1,466	37.5	31.3	31.3	100.0	32	642
45-49	56.3	35.2	8.5	100.0	71	1,514	45.7	39.1	15.2	100.0	46	932
50-54	63.6	22.4	14.0	100.0	107	2,205	56.7	31.7	11.7	100.0	60	1,269
55-59	72.5	21.7	5.8	100.0	120	2,536	69.8	20.6	9.5	100.0	63	1,286
Total	58.8	27.6	13.7	100.0	497	10,403	51.2	30.4	18.4	100.0	250	5,115
Education and deaths from the 2013 SIM (death records)
25-34	43.7	45.8	10.5	100.0	911	-	32.8	48.1	19.1	100.0	293	-
30-34	49.4	38.5	12.1	100.0	1.014	-	36.6	42.2	21.2	100.0	415	-
35-39	61.2	28.6	10.2	100.0	1.127	-	43.0	38.1	18.9	100.0	535	-
40-44	63.5	28.8	7.7	100.0	1.490	-	54.1	33.1	12.8	100.0	712	-
45-49	61.3	28.2	10.5	100.0	1.892	-	53.9	30.6	15.5	100.0	1.066	-
50-54	61.7	26.9	11.4	100.0	2.576	-	58.0	27.7	14.3	100.0	1.486	-
55-59	61.8	27.1	11.1	100.0	3.341	-	63.9	22.8	13.3	100.0	1.930	-
Total	59.5	29.9	10.6	100.0	12.351	-	54.9	30.0	15.1	100.0	6.437	-

Variable	Model 1 – Deaths from the 2010 Census, education level of household heads				Model 2 – Deaths from the 2010 Census, education statistically imputed				Model 3 – Deaths from the 2013 SIM
Variable	IRR	Standard error	CI-95%		IRR	Standard error	CI-95%		Model 3 – Deaths from the 2013 SIM
Men
Age
25-29	-		-	-	-		-	-	-
30-34	1.09	0.26	0.68	1.74	1.06*	0.25	0.66	1.69	*1.12+**
35-39	1.41	0.32	0.91	2.19	1.35*	0.30	0.87	2.09	*1.31+**
40-44	2.25	0.47	1.50	3.38	2.12*	0.43	1.41	3.16	*1.82+**
45-49	2.46	0.51	1.64	3.69	2.29*	0.47	1.53	3.41	*2.62+**
50-54	4.60	0.92	3.11	6.82	4.22*	0.85	2.85	6.26	*3.92+**
55-59	5.93	1.16	4.04	8.70	5.34*	1.02	3.68	7.75	*6.12+**
Education level
Low	-		-	-	-		-	-	-
Medium	0.73	0.08	0.59	0.90	0.43	0.05	0.34	0.55	0.45+
High	0.31	0.05	0.23	0.42	0.32*	0.05	0.25	0.43	0.23
Constant	0.0000	0.00	0.0000	0.0000	0.0000	0.00	0.0000	0.0000	0.0018+
Women
Age
25-29
30-34	0.99	0.36	0.49	2.01	0.96*	0.35	0.47	1.95	*1.40+**
35-39	0.78	0.30	0.36	1.68	0.74*	0.29	0.35	1.59	1.93*
40-44	2.25	0.75	1.17	4.33	2.10*	0.69	1.10	4.01	*2.67+**
45-49	3.08	0.97	1.67	5.70	2.84*	0.88	1.54	5.22	*4.19+**
50-54	5.49	1.98	2.70	11.14	4.98*	1.79	2.46	10.06	*6.19+**
55-59	5.81	1.86	3.10	10.88	5.17*	1.61	2.81	9.50	*9.21+**
Education level
Low	-		-	-	-			-	-
Medium	0.83	0.17	0.88	1.52	0.46	0.09	0.32	0.67	0.50+
High	0.40	0.10	0.39	0.82	0.43*	0.09	0.28	0.65	0.37+
Constant	0.0000	0.00	0.0000	0.0000	0.0000	0.00	0.0000	0.0000	*0.0005+**

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E-mail: editor@rebep.org.br

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[tfne2] Source: IBGE. 2010 Population Census; Mortality Information System (SIM), 2013.