Income inequality and elderly self-rated health in São Paulo, Brazil.

PURPOSE To test the association between income inequality and elderly self-rated health and to propose a pathway to explain the relationship. METHODS We analyzed a sample of 2143 older individuals (60 years of age and over) from 49 distritos of the Municipality of São Paulo, Brazil. Bayesian multilevel logistic models were performed with poor self-rated health as the outcome variable. RESULTS Income inequality (measured by the Gini coefficient) was found to be associated with poor self-rated health after controlling for age, sex, income and education (odds ratio, 1.19; 95% credible interval, 1.01-1.38). When the practice of physical exercise and homicide rate were added to the model, the Gini coefficient lost its statistical significance (P > .05). We fitted a structural equation model in which income inequality affects elderly health by a pathway mediated by violence and practice of physical exercise. CONCLUSIONS The health of older individuals may be highly susceptible to the socioeconomic environment of residence, specifically to the local distribution of income. We propose that this association may be mediated by fear of violence and lack of physical activity.