OP132 Inequalities in self-rated health in Ecuador: findings from ENSANUT 2018 survey

Background

Ecological studies report social inequalities in mortality and morbidity in Ecuador, but self-rated health (SRH) remains uninvestigated. This study aims to provide an overview of SRH inequalities by social determinants in the Ecuadorian population.

Methods

We conducted a secondary analysis of the 2018 National Health and Nutrition Survey (ENSANUT), a cross-sectional, nationwide, population-based survey that includes economic and health information of Ecuadorians of any age living in a selected household. It included 168,747 individuals (49% men and 51% women) living in 43,311 households. We dichotomized SRH as ‘poor’ if regular or bad health was reported and ‘good’ if good, very good, or excellent health. We investigated social inequalities in self-reported ethnicity and education and by quintiles of wealth based on Principal Component Analysis from 27 variables (covering public services, sanitation, housing, and assets). Regression analysis was used to estimate the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) for wealth and education, adjusted for sex and age.

Results

The overall prevalence of poor SRH was 23% in men and 25% in women. Regarding ethnicity, Montubios (a rural minority living on the Pacific coast) recorded the highest prevalence of poor SRH (36%) compared with mestizos or whites (23%), indigenous (22%), and afro-Ecuadorians (28%). A linear association between wealth quintiles and poor SRH was observed in both absolute and relative terms: the SII was 29%, CI: 27–31, and individuals in the poorest quintile were 5 times more likely to report poor health (RII 5.49, CI: 4.87–6.20) than those in the richest quintile. Strong linear associations were also observed with education (SII 39%, CI: 37–41); and subjects with no education were 7 times more likely to report poor health (RII 7.12, CI: 6.31–8.04) than those with tertiary education. The educational inequalities were larger among men (RII 8.30, CI: 7.07–9.74) than among women (RII 6.34, CI: 5.49–7.33).

Conclusion

Large inequalities by ethnicity, wealth, and education were observed in both men and women. Disadvantaged groups experienced worse SRH than advantaged groups. Inequalities in SRH in Ecuador appear larger than inequalities reported from other developed and developing countries. Ecuador’s poor health status could be improved by structural changes in access and quality of education, public services, sanitation, and housing that focus on racially excluded groups.