Trata-se de um estudo ecológico exploratório tipo comparação de múltiplos grupos. Objetivo: descrever o padrão de mortalidade da população a partir de estratos homogêneos de vulnerabilidade social dos municípios no Estado de São Paulo de 2003 a 2005. Método: Construção de estratos homogêneos, através de indicador composto por variáveis socioeconômicas e demográficas e comparação dos padrões de mortalidade através de taxas padronizadas. Resultados: Construção de cinco estratos homogêneos de vulnerabilidade social (Muito Fraca, Fraca, Intermediária, Intensa e Muito Intensa). Estimativas de risco mais elevadas para mortes maternas (27,82 a 56,22 %000 nascidos vivos), mortes infantis (12,48 a 16,20%0 nascidos vivos) e acidentes de transporte (14,68 a 24,06%000 hab.) foram mostradas nos estratos de maior vulnerabilidade declinando para os de menor vulnerabilidade. Para as Neoplasias (80,85 a 104,96 %000 hab.) e D. Infecciosas e Parasitárias (23,21 a 27,52 a %000 hab.) as mais elevadas ocorreram nos estratos de menor vulnerabilidade, declinando para os de maior vulnerabilidade. Para Diabetes Mellitus (17,36 a 23,57%000 hab.), D. Circulatórias (174,03 a 206,87%000 hab.), Homicídios (11,50 a 21,24%000 hab.) e, D. Respiratórias (62,58 a 75,54 %000 hab.), as mais elevadas situaram-se no estrato de vulnerabilidade social intermediária, declinando para os de maior vulnerabilidade, à exceção da Diabetes Mellitus. Conclusões: Foram evidenciadas desigualdades de mortalidade, apontando para grupos humanos com maiores necessidades de saúde, estratificação do risco epidemiológico e identificação de áreas críticas que indicam para a necessidade do desenvolvimento de políticas de saúde mais equitativas. / This is an ecologic exploratory study employing multiple group comparison. Objective: to describe mortality patterns of the population from homogeneous social vulnerable strata of the cities in the State of São Paulo, from 2003 to 2005. Method: Construction of homogeneous strata employing an indicator composed of socioeconomic and demographic variables and comparison of mortality patters through standardized rates. Results: Construction of five homogeneous social vulnerability strata (Very Weak, Weak, Intermediate, Intense and Very Intense). Risk estimates higher for maternal deaths (27,82 to 56,22 %000 live births), children deaths (12,48 to 16,20%0 live births) and transportation accidents (14,68 to 24,06%000 inhabitants) were shown in the strata of higher vulnerability, declining for those in lower vulnerability. For Neoplasias (80,85 to 104,96 %000 inhabitants) and Infectious and Parasitic diseases (23,21 a 27,52 a %000 inhabitants) higher rates corresponded to lower vulnerability strata, declining for those in higher vulnerability. Diabetes Mellitus (17,36 a 23,57%000 inhabitants), Homicides (11,50 a 21,24%000 inhabitants) and Respiratory Diseases (62,58 a 75,54 %000 inhabitants) higher rates were found at the intermediate social vulnerability stratum, declining for those in higher vulnerability, except for Diabetes Mellitus. Conclusions: Mortality inequalities became evident, pointing to human groups in higher health needs, stratification of the epidemiologic risk and identification of critical areas that show the need to develop more equitable health policies.

Trata-se de um estudo ecológico exploratório tipo comparação de múltiplos grupos. Objetivo: descrever o padrão de mortalidade da população a partir de estratos homogêneos de vulnerabilidade social dos municípios no Estado de São Paulo de 2003 a 2005. Método: Construção de estratos homogêneos, através de indicador composto por variáveis socioeconômicas e demográficas e comparação dos padrões de mortalidade através de taxas padronizadas. Resultados: Construção de cinco estratos homogêneos de vulnerabilidade social (Muito Fraca, Fraca, Intermediária, Intensa e Muito Intensa). Estimativas de risco mais elevadas para mortes maternas (27,82 a 56,22 %000 nascidos vivos), mortes infantis (12,48 a 16,20%0 nascidos vivos) e acidentes de transporte (14,68 a 24,06%000 hab.) foram mostradas nos estratos de maior vulnerabilidade declinando para os de menor vulnerabilidade. Para as Neoplasias (80,85 a 104,96 %000 hab.) e D. Infecciosas e Parasitárias (23,21 a 27,52 a %000 hab.) as mais elevadas ocorreram nos estratos de menor vulnerabilidade, declinando para os de maior vulnerabilidade. Para Diabetes Mellitus (17,36 a 23,57%000 hab.), D. Circulatórias (174,03 a 206,87%000 hab.), Homicídios (11,50 a 21,24%000 hab.) e, D. Respiratórias (62,58 a 75,54 %000 hab.), as mais elevadas situaram-se no estrato de vulnerabilidade social intermediária, declinando para os de maior vulnerabilidade, à exceção da Diabetes Mellitus. Conclusões: Foram evidenciadas desigualdades de mortalidade, apontando para grupos humanos com maiores necessidades de saúde, estratificação do risco epidemiológico e identificação de áreas críticas que indicam para a necessidade do desenvolvimento de políticas de saúde mais equitativas. / This is an ecologic exploratory study employing multiple group comparison. Objective: to describe mortality patterns of the population from homogeneous social vulnerable strata of the cities in the State of São Paulo, from 2003 to 2005. Method: Construction of homogeneous strata employing an indicator composed of socioeconomic and demographic variables and comparison of mortality patters through standardized rates. Results: Construction of five homogeneous social vulnerability strata (Very Weak, Weak, Intermediate, Intense and Very Intense). Risk estimates higher for maternal deaths (27,82 to 56,22 %000 live births), children deaths (12,48 to 16,20%0 live births) and transportation accidents (14,68 to 24,06%000 inhabitants) were shown in the strata of higher vulnerability, declining for those in lower vulnerability. For Neoplasias (80,85 to 104,96 %000 inhabitants) and Infectious and Parasitic diseases (23,21 a 27,52 a %000 inhabitants) higher rates corresponded to lower vulnerability strata, declining for those in higher vulnerability. Diabetes Mellitus (17,36 a 23,57%000 inhabitants), Homicides (11,50 a 21,24%000 inhabitants) and Respiratory Diseases (62,58 a 75,54 %000 inhabitants) higher rates were found at the intermediate social vulnerability stratum, declining for those in higher vulnerability, except for Diabetes Mellitus. Conclusions: Mortality inequalities became evident, pointing to human groups in higher health needs, stratification of the epidemiologic risk and identification of critical areas that show the need to develop more equitable health policies.

Comme plusieurs pays industrialisés, le Canada fait face à un vieillissement de sa population qui est exacerbé par la baisse de la mortalité aux âges adultes et avancés. Pour atténuer les conséquences du vieillissement de la population, le Canada a recours à une immigration internationale qui s’est beaucoup diversifiée quant au lieu de naissance des arrivants depuis quelques décennies. Dans ce contexte, il est intéressant de s’interroger sur le comportement différentiel des immigrants selon leur provenance en comparaison avec les Canadiens de naissance. Notre recherche s’inscrit plus précisément sous la thématique mortalité et elle a pour objectif d’étudier les disparités dans la distribution des décès par âge et par sexe selon la provenance, cette dernière étant comprise d’une double manière, soit selon une perspective géographique, soit selon le niveau de développement du pays de naissance. En utilisant une approche de lissage par P-splines, nous estimons l’âge modal (i.e. le plus commun) au décès et la dispersion des durées de vie au mode pour les divers groupes d’immigrants à l’étude et les natifs. Nos résultats montrent que la mortalité aux grands âges résumée par l’âge modal au décès, M, est plus faible pour l’ensemble des immigrants qu’au sein de la population native. L’écart est plus élevé chez les hommes et relativement faible chez les femmes, tout en étant statistiquement significatif. La répartition des décès selon l’âge des immigrants est plus concentrée autour de son centre que celle des natifs, indiquant une plus grande homogénéité des durées de vie individuelles aux âges avancés. L’âge modal au décès estimé pour chacune des catégories de provenance considérées séparément, soit selon la région géographique, soit selon l’indice de développement humain, présente des différences statistiquement significatives par rapport à la population native, à l’exception des femmes Britanniques et celles de l’Afrique et du Moyen-Orient. De plus, certaines différences significatives en matière d’âge modal au décès sont observées lors de la comparaison des groupes d’immigrants entre eux. Le phénomène de sélection, à la fois dans le pays de provenance et dans celui de destination, est l’explication la plus plausible pour ces différences et elle est discutée dans ce mémoire. / Like many industrialized countries, Canada is facing an aging population that is exacerbated by the decline in mortality in adulthood and advanced ages. To mitigate the consequences of an aging population, Canada has resorted to international immigration, which has greatly diversified in terms of the place of birth of arrivals in recent decades. In this context, it is interesting to study the differential behavior of immigrants according to their origin compared to native-born Canadians. Our research focuses specifically under the theme of mortality and its objective is to study the disparities in the distribution of deaths by age and sex according to origin, the latter being twofold, i.e., from a geographical perspective, or according to the level of development of the country of birth. Using a P-spline smoothing approach, we estimate the modal (i.e., the most common) age at death and the dispersion of mode lifespans for the various immigrant groups under study and natives. Our results show that mortality at older ages, summarized by the modal age at death, M, is lower among immigrants than for the native population. The difference is higher for men and relatively small for women, while still being statistically significant. The distribution of deaths by age of immigrants is more concentrated around its center than that of natives, indicating a greater homogeneity of individual lifespans at advanced ages. The estimated modal age at death for each of the categories of origin considered separately, either by geographic region or by HDI, shows statistically significant differences compared to the native population, with the exception of women from the United Kingdom and from Africa and the Middle East. In addition, some significant differences in the modal age at death are observed when comparing immigrant groups with each other. The phenomenon of selection in both the country of origin and the country of destination is the most plausible explanation for these differences and is discussed in this thesis.

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