Inequalities in the use of health services by adults and elderly people with and without noncommunicable diseases in Brazil, 2019 National Health Survey.

Deborah Carvalho Malta,Margareth Guimarães Lima,Crizian Saar Gomes,Regina Tomie Ivata Bernal,Laís Santos De Magalhães Cardoso,Marilisa Berti De Azevedo Barros

doi:10.1590/1980-549720210003.supl.2

Abstract

The objective of this study was to investigate the use of health services and limitations in performing usual activities by adults and elderly people with and without noncommunicable chronic diseases (NCDs), according to sociodemographic strata. This is a cross-sectional study in which data from the 2019 National Health Survey were analyzed. The final sample corresponded to 88,531 households with interviews carried out, referring to individuals aged 18 years and above. The prevalence of use of services by the population with NCDs was compared with that of the population without NCDs and stratified by socioeconomic and demographic variables. Prevalence ratios (PRs) and 95% confidence intervals (95%CI) were calculated. In 2019, 47.6% (95%CI 47.0-48.3) of the population reported having one or more NCDs. Population with NCDs had more medical consultations in the last 12 months (adjusted PR [APR]=1.21; 95%CI 1.20-1.23), used more health services in the last 2 weeks (APR=2.01; 95%CI 1.91-2.11), were referred to more hospitalization (APR=2.11; 95%CI 1.89-2.36), and had more limitations in performing usual activities (APR=2.52; 95%CI 2.30-2.76), compared with the population without NCDs. A positive dose-response gradient was observed between the number of comorbidities and the use of services. In all socioeconomic and demographic strata, the prevalence of indicators was higher in people with NCDs. The presence of NCDs was associated with a higher frequency of use of health services (i.e., consultation, use of services, and hospitalization) and the restriction of usual activities in all socioeconomic and demographic strata.

Highlights

Noncommunicable chronic diseases (NCDs) are responsible for about 41 million deaths each year, that is, 71% of all deaths in the world, of which about 15 million deaths occurred in individuals with ages between 30 and 69 years, which are, considered premature deaths[1,2]
Some strata had a higher prevalence of medical appointments in individuals with or without NCD: women (92.83%; 95% confidence intervals (95%CI) 92.23-93.42), elderly (93.66%; 95%CI 93.14-94.18), individuals with higher education (92.84%; 95%CI 91.76-93.92) and income (93.40%; 95%CI 92.20-94.60), individuals with health insurance (95.57%; 95%CI 94.93-96.20), and residents in the Southeast (91.77%; 95%CI 90.89-92.65) and South (91.44%; 95%CI 90.43-92.46) regions
The adjusted PRs (APRs), comparing people with and without NCDs in each stratum, revealed that the presence of NCDs increased consultations in the last year among men (APR=1.31; 95%CI 1.28-1.33), in the elderly (APR=1.27; 95%CI 1.24–1.31), in those with less education (APR=1.32; 95%CI 1.29-1.35) and lower income (APR=1.27; 95%CI % 1.25-1.29), in those who do not have health insurance (APR=1.26; 95%CI 1.24-1.28), and among residents in the Northern (APR=1.26; 95%CI 1.23-1.31) and Northeast (APR=1.26; 95%CI 1.23-1.29) regions compared with the Southeast region (Table 1)

Summary

Introduction

Noncommunicable chronic diseases (NCDs) are responsible for about 41 million deaths each year, that is, 71% of all deaths in the world, of which about 15 million deaths occurred in individuals with ages between 30 and 69 years, which are, considered premature deaths[1,2]. Cardiovascular disease ranks first (17.9 million), followed by cancer (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million)[2]. These four groups of diseases are responsible for more than 80% of all premature deaths from NCDs2,3. NCDs and their risk factors tend to be higher in populations of low socioeconomic status, residing in poor or marginalized communities. They represent an important cause of the impoverishment of families and exacerbate economic inequalities within societies[4]. Coping with NCDs involves ensuring access to treatment and other care, health promotion, and prevention, as well as organizing surveillance and monitoring of these diseases, in addition to mitigating social determinants through poverty reduction and of social inequality, themes that are integrated to the Sustainable Development Goals[2,3,7]

Methods

Results

Conclusion