Brazilian National Health Survey Research Articles

Functional limitation in the older Brazilian adults: Association with multimorbidity and socioeconomic conditions.

The aim of this study was to assess the association between multimorbidity and the presence of functional limitation in basic (BADL) and instrumental activities of daily living (IADL) among Brazilian older adults and to verify whether this association is moderated by socioeconomic conditions. Cross-sectional study with data from the Brazilian National Health Survey (PNS) (2019) for the Brazilian population aged 60 years and over. The dependent variables were functional limitation, based on self-reported difficulty in performing one or more activities of daily living, including six BADL (feeding, bathing, using the toilet, dressing, crossing a room on the same floor and getting out of bed) and four IADL (shopping, managing money, taking medication and using transportation). The independent variables were multimorbidity (presence of two or more self-reported chronic diseases) and socioeconomic measures (per capita household income, asset score, and education level). The association between multimorbidity and outcomes was assessed using adjusted logistic regression models. The moderating effect of socioeconomic conditions on the association between multimorbidity and functional limitations was assessed by including an interaction term. The final sample consisted of 22,725 individuals. The prevalence of functional limitation was 8.5% (95%CI: 7.9-9.2) and 18.6% (95%CI: 17.8-19.5) in BADL and IADL, respectively. Multimorbidity was associated with BADL [OR: 2.30 (95%CI: 1.93-2.74)] and IADL [OR: 2.26 (95%CI: 1.98-2.57)]. The odds of functional limitation were higher among individuals with lower levels of education and income, but there was no interaction between multimorbidity and socioeconomic position measures. Multimorbidity was associated with functional limitation (BADL and IADL) and socioeconomic conditions, and this association was constant across socioeconomic position levels.

Reported recommendations to address cardiovascular risk factors differ by socio-economic status in Brazil. Results from the Brazilian National Health Survey 2019

BackgroundManagement of cardiovascular risk factors (high cholesterol, diabetes, and hypertension) should start by implementing a healthy lifestyle. Whereas lifestyle recommendations are provided irrespective of the patient’s socio-economic status has not been recently assessed in the Brazilian population. AimsTo assess the preventive measures against cardiovascular risk factors according to educational level and income in the Brazilian population. MethodsSurvey data of the 2019 Brazilian National Health Survey (PNS). The PNS is a nationwide household-based survey carried out by the Brazilian Ministry of Health. The PNS included face-to-face interviews and collected information on lifestyle management of high cholesterol, diabetes, and hypertension by a healthy diet, an adequate weight, exercise, and quitting smoking. The participant’s educational level and income (in multiples of the basic salary per capita) was collected. ResultsOf the 88,052 participants included, 13,151 (14.9%), 6,986 (7.9%) and 22,516 (25.6%) reported being diagnosed with high cholesterol, diabetes, or hypertension, respectively. Dietary recommendations were the most frequently provided (94.5%, 94.6% and 88.1% for high cholesterol diabetes, and hypertension, respectively), while recommendations to quit smoking to current smokers were the least frequently provided (74.9%, 85.8% and 81.1% for high cholesterol, diabetes, and hypertension, respectively). After multivariable adjustment, participants with a higher educational level or a higher income had a higher likelihood of reporting receipt lifestyle recommendations for high cholesterol or hypertension, while no associations were found for most recommendations for diabetes. ConclusionBetter-educated, wealthier Brazilians report receiving more lifestyle recommendations regarding high cholesterol and hypertension management more frequently than lower-educated or with low-income.

Prevalence and factors associated with possible cases of familial hypercholesterolemia in Brazilian adults: a cross-sectional study

This study aimed to estimate the prevalence of possible cases of FH and analyze associated factors in the adult Brazilian population. Cross-sectional study with laboratory data from the Brazilian National Health Survey, with 8521 participants. Possible cases of FH were defined according to the Dutch Lipid Clinic Network criteria. The prevalence and 95% confidence intervals (95% CI) of possible cases of FH were estimated according to sociodemographic variables, lifestyle, diabetes, hypertension, altered tests, treatment and self-rated health. Logistic regression was used to analyze the associations. The prevalence of possible cases of FH was 0.96%, higher in women, between 45 and 59 years, white race/skin color and others, less education, people with diabetes, hypertension and total cholesterol ≥ 310 mg/dL. The presence of FH was positively associated with regular self-rated health (OR 1.96; 95% CI 0.99–3.84), poor/very poor (OR 3.02; 95% CI 1.30–7.03) and negatively with black race/skin color (OR 0.10; 95% CI 0.02–0.46) and complete elementary school, incomplete high school (OR 0.47; 95% CI 0.23–0.98) and complete high school and more (OR 0.45; 95% CI 0.21–0.95). FH affects 1:104 Brazilian adults, these findings contribute to understanding the burden of disease in Brazil. Due to the scarcity of studies on FH in low- and middle-income countries, further studies are desirable.

Smoking in Brazil

Introduction: Tobacco use through its different forms continues to be one of the leading preventable causes of death in Brazil. As a remarkable success story, Brazil has achieved one of the largest significant declines in smoking prevalence since 1990. However, worryingly, the rate of decline in tobacco consumption has decreased in recent years, as suggested by surveys. Objectives: The current study aimed to compare the results of three household surveys carried out by the Brazilian Institute of Geography and Statistics (IBGE). Methods: We compared the prevalence of tobacco use among informants aged 18 years or older and the percentage of prevalence changes between 2008, 2013, and 2019 using data from 3 surveys: The Global Tobacco Adult Survey (2008) and the Brazilian National Health Survey (2013 and 2019). In addition, we analyzed the prevalence for Brazil and states according to age, gender, educational level, and race. Results: The prevalence of active smoking decreased by 19% between 2008 and 2013, from 18,2% (95% CI: 17,7;18,7%) in 2008 to 14.7% (95% CI: 14.2;15.2%) in 2013. However, in 2019, the prevalence was 12.6% (95% CI: 12.2;13.0%) revealing a 14.3% reduction. Smoking was higher among low educational levels population, lower income status, and black and mixed race/skin color. Conclusion: The prevalence of smoking has decreased in Brazil in the past three decades. However, recently there has been a reduction in the intensity of decrease, demanding attention and careful analysis of smoking prevention and cessation strategies.

Explaining public dental service utilization: A theoretical model.

Constructing and validating a theoretical model of relationships between dental services use and socioeconomic characteristics, oral health status, primary care coverage, and public dental services. The first stage of the study consisted of developing a theoretical-conceptual model to demonstrate the expected relationships between variables based on the literature. In the second stage, we tested the proposed theoretical model using the Partial Least Squares Structural Equation Modeling (PLS-SEM) technique, using data from the Brazilian National Health Survey conducted in 2019 with a sample of 41,664 individuals aged 15 or older. This study successfully defined a theoretical model that explains the systematic relationships involving public dental services utilization. Socioeconomic status was negatively associated with oral health status (β = -0.376), enrollment in primary care facilities (β = -0.254), and the use of public dental consultations (β = -0.251). Being black, indigenous, or living in a rural area was directly associated with lower socioeconomic status and greater use of public dental services. The identified relationships, establishing a theoretical basis for further investigations, also provide evidence of a public access policy's effect on oral health services on equity, supporting the construction of more effective and equitable public policies.

Urban-rural health disparities in Brazil: Do sociodemographic attributes play a role?

The debate over urban-rural health disparities in Latin American countries is disputed, and this relationship may not be as straightforward as initially thought. In this study, we investigate whether individual-level self-rated health (SRH) varies across urban and rural populations in the country and how sociodemographic attributes are associated with such differences. We relied on data from the Brazilian National Health Survey (n = 78,806), a nationwide household-based survey conducted in 2019 that is representative of Brazil, geopolitical macro-regions, states, and 27 state capitals. Logistic regression models were used to test for differences in SRH between urban and rural inhabitants. The findings suggest that Brazilian adults living in rural areas are at a higher risk of perceiving their health as poor than their urban counterparts. The urban-rural health disparities are significant and influenced by sociodemographic attributes, highlighting the importance of developing public health interventions to improve health outcomes in these populations.

Differential Factors Are Associated with Physical Activity in Older Adults in Brazil with and without Non-Communicable Chronic Diseases: A Cross-Sectional Analysis of the 2019 National Health Survey.

This study analyzed whether sociodemographic factors, health perception, dietary habits, and screen time are related to physical activity (PA) in older people with and without non-communicable chronic diseases (NCDs). This cross-sectional study analyzed data from the 2019 Brazilian National Health Survey; the sample was older adults (≥60 years old; n = 22,726). The outcome of this study was being physically active or inactive during leisure time, and NCD was used as a moderating variable. The correlates investigated were sociodemographic and health-related variables. According to the logistic regression analysis, it was observed that being male had an association only in the group with NCDs (OR = 1.25 (1.05-1.48)), as well as residing in the northeastern region (OR = 1.26 (1.04-1.53)). On the other hand, high levels of education (OR = 4.09 (2.92-5.2); OR = 1.92 (1.48-2.49)) and income (OR = 1.64 (1.09-2.48); OR = 1.86 (1.33-2.60)) were associated with PA in both groups, as well as dietary habits (OR = 1.03 (1.01-1.05); (OR = 1.05 (1.04-1.07)). Advanced age (OR = 0.96 (0.94-0.97); OR = 0.97 (0.96-0.98)) and reporting a regular health perception (OR = 0.53 (0.43-0.66); OR = 0.61 (0.52-0.73)) were factors associated with physical inactivity in both groups. Gender, education, and income were unequally associated with an active lifestyle in both groups, and therefore, barriers to PA may arise.

Use of integrative and complementary health practices by Brazilian population: results from the 2019 National Health Survey

BackgroundIn 2006, Brazil implemented the National Policy on Integrative and Complementary Practices of the SUS. and in 2015, the Brazilian Ministry of Health issued a reinforcement to this policy to increase access to integrative and complementary health practices (ICHP). In this study, we described the prevalence of ICHP in Brazilian adults according to their sociodemographic characteristics, self-perceived health, and chronic diseases.MethodsThis is a nationally representative cross-sectional survey including 64,194 participants from the 2019 Brazilian National Health Survey. Types of ICHP were categorized according to their purposes: health promotion (Tai chi/Lian gong/Qi gong, yoga, meditation, and integrative community therapy) or therapeutic practices (acupuncture, auricular acupressure, herbal treatment and phytotherapy, and homeopathy). Participants were classified as non-practitioners and practitioners, who in turn were grouped according to use of ICHP in the last 12 months: only used health promotion practices (HPP); only used therapeutic practices (TP); used both (HPTP). Multinomial logistic regressions were performed to estimate the associations of ICHP with sociodemographic characteristics, self-perceived health status, and chronic diseases.ResultsBrazilian adults showed an ICHP use prevalence of 6.13% [95%CI = 5.75–6.54]. Compared to non-practitioners, women and middle-aged adults were more likely to use any ICHP. Afro-Brazilians were less likely to use both HPP and HPTP, whereas Indigenous people were more likely to use both HPP and TP. We found a positive gradient of association among participants with higher income and educational attainment and access to any ICHP. People from rural areas and those with negative self-perceived health were more likely to use TP. Participants with arthritis/rheumatism, chronic back problems, and depression were more likely to use any ICHP.ConclusionsWe found that 6% of Brazilian adults reported using ICHP in the previous 12 months. Women, middle-aged individuals, chronic patients, people with depression, and wealthier Brazilians are more likely to use any type of ICHP. Of note, rather than suggesting to expand the offer of these practices in the Brazilian public health system, this study diagnosed Brazilians’ behavior of seeking for complementary healthcare.

Prediction of Multimorbidity in Brazil: Latest Fifth of a Century Population Study.

Multimorbidity is characterized by the co-occurrence of 2 or more chronic diseases and has been a focus of the health care sector and health policy makers due to its severe adverse effects. This paper aims to use the latest 2 decades of national health data in Brazil to analyze the effects of demographic factors and predict the impact of various risk factors on multimorbidity. Data analysis methods include descriptive analysis, logistic regression, and nomogram prediction. The study makes use of a set of national cross-sectional data with a sample size of 877,032. The study used data from 1998, 2003, and 2008 from the Brazilian National Household Sample Survey, and from 2013 and 2019 from the Brazilian National Health Survey. We developed a logistic regression model to assess the influence of risk factors on multimorbidity and predict the influence of the key risk factors in the future, based on the prevalence of multimorbidity in Brazil. Overall, females were 1.7 times more likely to experience multimorbidity than males (odds ratio [OR] 1.72, 95% CI 1.69-1.74). The prevalence of multimorbidity among unemployed individuals was 1.5 times that of employed individuals (OR 1.51, 95% CI 1.49-1.53). Multimorbidity prevalence increased significantly with age. People over 60 years of age were about 20 times more likely to have multiple chronic diseases than those between 18 and 29 years of age (OR 19.6, 95% CI 19.15-20.07). The prevalence of multimorbidity in illiterate individuals was 1.2 times that in literate ones (OR 1.26, 95% CI 1.24-1.28). The subjective well-being of seniors without multimorbidity was 15 times that among people with multimorbidity (OR 15.29, 95% CI 14.97-15.63). Adults with multimorbidity were more than 1.5 times more likely to be hospitalized than those without (OR 1.53, 95% CI 1.50-1.56) and 1.9 times more likely need medical care (OR 1.94, 95% CI 1.91-1.97). These patterns were similar in all 5 cohort studies and remained stable for over 21 years. A nomogram model was used to predict multimorbidity prevalence under the influence of various risk factors. The prediction results were consistent with the effects of logistic regression; older age and poorer participant well-being had the strongest correlation with multimorbidity. Our study shows that multimorbidity prevalence varied little in the past 2 decades but varies widely across social groups. Identifying populations with higher rates of multimorbidity prevalence may improve policy making around multimorbidity prevention and management. The Brazilian government can create public health policies targeting these groups, and provide more medical treatment and health services to support and protect the multimorbidity population.

For lifestyle recommendations, better be rich and well educated

Abstract Funding Acknowledgements Type of funding sources: None. Background Management of cardiovascular risk factors (diabetes, hypertension, and high cholesterol levels) should start by implementing a healthy lifestyle. Whereas lifestyle recommendations are provided irrespective of the patient’s socio-economic status has not been recently assessed in the Brazilian population. Aims To assess the preventive measures against cardiovascular risk factors according to educational level and income in the Brazilian population. Methods We used survey data of the 2019 Brazilian National Health Survey (PNS). The PNS is a nationwide household-based survey carried out by the Brazilian Ministry of Health. The PNS included face-to-face interviews and collected information on lifestyle management of diabetes, hypertension and high cholesterol levels by a healthy diet, an adequate weight, and quitting smoking. Information on the participant’s educational level and income (in multiples of the basic salary per capita) was also collected. Results Of the 81,197 participants included, 7,293 (9.0%), 23,065 (28.4%) and 13,304 (16.4%) reported being diagnosed with diabetes, hypertension, and high cholesterol levels, respectively. Dietary recommendations were the most frequently provided (94.8%, 94.6% and 88.6% for diabetes, hypertension, and high cholesterol levels, respectively), while recommendations to stop smoking were the least frequently provided (72.6%, 62.0% and 68.2% for diabetes, hypertension and high cholesterol levels, respectively). After multivariate adjustment, participants with a higher educational level or a higher income had a higher likelihood of being given lifestyle recommendations for hypertension or high cholesterol, while no significant trends were found for most recommendations for diabetes; see table, significant (p<0.05) trends are in grey background. Conclusion Better educated, wealthier Brazilians benefit more from lifestyle recommendations regarding cardiovascular risk factor management. This could impact the incidence of CVD according to socioeconomic groups.

HOW THE PAST SHAPES CURRENT STORIES: (EPI)GENETIC EPIDEMIOLOGICAL PROFILES OF METABOLIC SYNDROME IN BRAZILIAN MENNONITES

Mennonites present cc. 500 years genetic isolation and three bottleneck events that reducedtheir genetic diversity. In order to identify (epi)genetic markers for metabolic syndrome (MS),we used a modified version of the Brazilian National Health Survey to interview 762Mennonites from three settlements, between 2016-2023. We compared 63 vs. 127 exomes(Illumina HiSeq) from Mennonites with/without metabolic syndrome (MS) and genotypedcandidate variants in regulatory regions with mass spectrometry (iPLEX) and sequence-specific amplification (PCR-SSP). We also evaluated DNA methylation of the NR3C1 andFKBP5 genes in peripheral blood mononuclear cells (PBMCs) of up to 66 and 141 individualswith/without MS. MS prevalence was 14.02%, less than half the one reported forNeobrazilians (34.8%, P<0.00001), being paralleled by a three times lower prevalence ofacute myocardial infarction (AMI). Among independent MS risk factors, we found lowermaternal warmth in infancy (OR=1.59, P=0.019) and a higher susceptibility to AMI with theharshest migratory route to Brazil (OR=1.57, P=0.001). Thirty-nine variants of 34 genes wereassociated with MS (p<0.02), 41% create/disrupt CpG sites and 12 were associated withvisceral adipose and/or cardiovascular tissue expression. There were no methylationdifferences between individuals with and without MS in PBMCs with the NR3C1 and FKBP5genes, pointing to other epigenetic causal effects. In conclusion, Mennonites have a peculiarepidemiological profile marked by (epi)genetic founder effects that also affect theirmetabolism, calling for urgent action for prevention and to alleviate the burden ofcomorbidities due to late diagnosis.

A better lifestyle favors the adoption of integrative and complementary therapies: the brazilian national health survey

A better lifestyle favors the adoption of integrative and complementary therapies: the brazilian national health survey

Prevalence of depressive symptoms and its association with social support among older adults: The Brazilian National Health Survey

BackgroundThe study aimed to assess the association between depressive symptoms and social support measures among non-institutionalized Brazilian older adults. MethodsA cross-sectional study was carried out with data from the last National Health Survey, conducted in 2019. A descriptive analysis of the study variables was performed, followed by a multiple regression analysis to teste the association between the dependent variable (depressive symptoms, assessed by the Patient Health Questionnaire (PHQ-9) and independent variables (household arrangement, marital relationship, leisure activities, voluntary activity, religious activity, activities in associations/leaderships, work and receiving social support (friends and family). ResultsThe sample comprised 22,723 older adults and 13.1 % had depressive symptoms. There was a positive relationship between the number of people in the household and the prevalence of depressive symptoms. Individuals with support from family members only (PR 0.69; 95 % CI 0.51; 0.92) and those with support from family and friends (PR 0.53 95 % CI 0.40; 0.70) had a lower prevalence of depressive symptoms than those without support. Participation in leisure and religious activities was inversely associated with depressive symptoms. A negative association was found between work and the presence of depressive symptoms (PR 0.83; 95 % CI 0.70; 0.99). LimitationsThe cross-sectional design limits causal inferences and the survey did not include institutionalized individuals. ConclusionsThe lower prevalence of the outcome among older adults with social support highlights the importance of evaluating these measures and practicing activities that allow personal and social interactions among this age group.

Self-Reported Chronic Back Pain and Current Depression in Brazil: A National Level Study.

There is limited literature investigating the association between chronic back pain (CBP) and depression in Brazil. This study evaluates the association between CBP, CBP-related physical limitations (CBP-RPL), and self-reported current depression (SRCD), in a nationally representative sample of Brazilian adults. The data for this cross-sectional study came from the 2019 Brazilian National Health Survey (n = 71,535). The Personal Health Questionnaire depression scale (PHQ-8) was used to measure the SRCD outcome. The exposures of interest were self-reported CBP and CBP-RPL (none, slight, moderate, and high limitation). Multivariable weighted and adjusted logistic regression models were used to investigate these associations. The weighted prevalence of SRCD among CBP was 39.5%. There was a significant weighted and adjusted association between CBP and SRCD (weighted and adjusted odds ratio (WAOR) 2.69 (95% CI: 2.45-2.94). The WAOR of SRCD among individuals with high, moderate, and slight levels of physical limitation was significantly greater than for those without physical limitation due to CBP. Among Brazilian adults with high levels of CBP-RPL, there was over a five-fold increased risk of SRCD compared to those without CBP-RPL. These results are important for increasing awareness of the link between CBP and SRCD and for informing health services policies.

Association between impairment and self-rated health: a brazilian population study considering type, origin, and degree of limitation

BackgroundPerceived health is a well-known, low-cost measure in public health, and has been used in several studies on individuals with impairment. Although many studies have related impairment to self-rated health (SRH), few have considered the origin and degree of limitation of the impairment. This study examined whether physical, hearing, or visual impairments—when analyzed according to origin (congenital or acquired) and degree of limitation (with or without)—are associated with the SRH status.MethodsThis cross-sectional study used data of 43,681 adult individuals from the Brazilian National Health Survey (NHS, 2013). The outcome SRH was dichotomized into poor (including the regular, poor, and very poor responses) or good (including the good and very good responses). Crude and adjusted (for socio-demographic characteristics and chronic diseases history) prevalence ratios (PR) estimates were evaluated using Poisson regression models with the robust variance estimator.ResultsPoor SRH prevalence was estimated at 31.8% (95%CI:31.0–33.0) among the non-impaired population, 65.6% (95%CI:60.6–70.0) among individuals with physical impairment, 50.3% (95%CI:45.0–56.0) for people with hearing impairment, and 55.3% (95%CI:51.8–59.0) for the visually impaired. Individuals with congenital physical impairment—with or without limitations—presented the strongest association with the poorest SRH status. Participants with non-limiting, congenital hearing impairment showed a protective factor to poor SRH (PR = 0.40 95%CI: 0.38–0.52). Individuals with acquired visual impairment with limitations demonstrated the strongest association with poor SRH (PR = 1.48 95%CI:1.47–1.49). Among the impaired population, middle-aged participants showed a stronger association with poor SRH than older adult participants.ConclusionsImpairment is associated with poor SRH status, especially among people with physical impairment. The origin and degree of limitation of each type of impairment differently impacts SRH among the impaired population.

Access to diabetes diagnosis in Brazil based on recent testing and consultation: The Brazilian national health survey, 2013 and 2019.

Screening for undiagnosed diabetes using glucose testing is recommended globally to allow preventive action among those detected. Our aim was to evaluate the access to glucose testing to screen for diabetes in Brazil using self-reported information on recent testing and medical consultation from national surveys of Brazilian adults. The Pesquisa Nacional de Saúde (PNS) was conducted in 2013 and 2019 drawing probabilistic samples of Brazilians aged 18 years and above. To evaluate glucose testing among those undiagnosed, we excluded those self-reporting a previous diagnosis of diabetes. We then defined recent access to diabetes diagnosis by considering the previous two years and choosing the last blood glucose test and the proximal medical consultation reported. We used Poisson regression with robust variance to assess correlates of access, expressing them with adjusted prevalence ratios (PR) and their 95% confidence intervals. Access to recent glucose testing documented that over 70% reported a recent glycemic test, 71% in 2013, and 77% in 2019. These findings are consistent with a wide recent access to medical consultation, 86% and 89% in 2013 and 2019, respectively. Reporting recent glucose testing and medical consultation may better reflect the actual access to medical diagnostic testing. When analyzing this joint outcome, diagnostic access was still wide, 67% and 74%, respectively. Greater access (p< 0.001) was seen for women (PR=1.16; 1.15-1.17), older individuals (PR=1.25; 1.22-1.28), and those with higher education (PR=1.17; 1.15-1.18), obesity (PR=1.06; 1.05-1.08), and hypertension (PR=1.12; 1.11-1.13). In contrast, lower access (p<0.001) was seen for those declaring being Black (PR=0.97; 0.95-0.99) or of mixed-race (PR=0.97; 0.96-0.98), those residing in rural areas (PR=0.89; 0.87-0.90), and not having a private health insurance plan (PR=0.85; 0.84-0.86). Although access to diagnostic testing for diabetes is high in Brazil, partly due to its universal health system, social inequities are still present, demanding specific actions, particularly in rural areas and among those self-declaring as being Black or mixed-race.

Panorama of Intimate Partner Violence Against Women in Brazil and its Association With Self-Perception of Health: Findings From a National Representative Survey.

Intimate partner violence (IPV) is a challenge in Brazil. The country holds one of the highest rates of femicide in the world, most of which are preceded by IPV. We conducted a cross-sectional study with 34,334 women, aged 18 to 59 years, from the 2019 Brazilian National Health Survey to analyze the prevalence of IPV and its subtypes among the Brazilian adult women in the last 12 months, encompassing their health consequences and the use of health services resulting from IPV. We also used logistic regression models to estimate the association of sociodemographic characteristics and self-perceived health status with IPV. The prevalence of IPV among Brazilian adult women in the last 12 months was 7.6% (95% confidence interval [CI] [7.0, 8.2]). Women aged 18 to 39 years, not married, and with income of up to 1 minimum wage (MW), had higher odds of suffering IPV. Among those who reported health consequences due to IPV, 69% reported psychological consequences, and 13.9% sought health care, mostly in primary or secondary health care services in the Brazilian Unified Health System (41.9%). Regarding the self-perceived health variables, women who reported eating problems (odds ratio [OR] = 1.29; [1.01, 1.65]), lack of interest/absence of pleasure (OR = 1.41; [1.11, 1.79]), depressive feelings (OR = 1.39; [1.03, 1.88]), feeling of failure (OR = 1.75; [1.36, 2.24]), and suicidal thoughts (OR = 1.73; [1.25, 2.41]) had greater odds of reporting IPV compared to those who did not report these same perceptions. The results show that younger, divorced or single, low-income women with eating problems and mental health disorders were more likely to suffer IPV. IPV often led to health problems, and many abused women sought support from public health services. Health professionals must be trained to identify and care for these women, thereby acting as allies in preventing and reducing IPV.

Sexual Orientation Disparities in Depression and Substance Use Among Adults: Results from the Brazilian National Health Survey 2019.

Purpose: We compared the prevalence of depression, hazardous alcohol use, daily tobacco use, and hazardous alcohol and tobacco use (HATU) by sexual orientation and sex among Brazilian adults. Methods: Data were obtained from a national health survey conducted in 2019. This study included participants aged 18 years and older (N = 85,859). Adjusted prevalence ratios (APRs) and confidence intervals were estimated using Poisson regression models stratified by sex to examine the association between sexual orientation, depression, daily tobacco use, hazardous alcohol use, and HATU. Results: After controlling for the covariates, gay men showed a higher prevalence of depression, daily tobacco use, and HATU compared with heterosexual men (APR ranged from 1.71 to 1.92). Furthermore, bisexual men showed a higher prevalence (almost three times) of depression compared with heterosexual men. Lesbian women showed a higher prevalence of binge and heavy drinking, daily tobacco use, and HATU compared with heterosexual women (APR ranged from 2.55 to 4.44). Among bisexual women, the results were significant for all analyzed outcomes (APR ranged from 1.83 to 3.26). Conclusions: This study was the first to use a nationally representative survey to assess sexual orientation disparities related to depression and substance use by sex in Brazil. Our findings highlight the need for specific public policies aimed at the sexual minority population and for greater recognition and better management of these disorders by health professionals.

Does occupation moderate the association between domain-based physical activity and depressive symptoms?

Our aim was to test the potential moderating role of occupation type in the association between the domains of physical activity and depressive symptoms. We used data of 51,895 adults (44.8% women, 40.7 ± 13.3 years), currently employed, from the 2019 Brazilian National Health Survey. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Self-reported physical activity (min/week) was assessed in four domains (i.e., leisure-time, transportation, occupational, and household). Type of occupation was characterized into five categories according to the International Standard Classification of Occupations: 1) Managers/qualified professionals, 2) Technicians/associate professionals, 3) Clerks/service workers, 4) Qualified manual workers, 5) Elementary manual workers. Age, ethnicity, educational level, income, and TV-viewing were used as covariates. Poisson regression was used for the analysis of association and moderation, through the inclusion of interaction terms. In the whole sample, leisure-time physical activity was associated with lower depressive symptoms, while transportation, occupational and household physical activity were associated with higher depressive symptoms. Type of occupation modified the association between leisure-time physical activity and depressive symptoms. That is, compared to managers/qualified professionals, leisure-time physical activity had larger associations with increased depressive symptoms in technicians/associate professionals (considering an increase of 100 min/wk of physical activity: unstandardized coefficient [B]:0.073, 95%CI:0.024; 0.121), qualified (B:0.067, 95%CI:0.025; 0.110) and elementary (B:0.065, 95%CI:0.016; 0.115) manual workers than among managers/qualified professionals. Stratified analyzes by occupation suggested that leisure-time physical activity was associated with lower depressive symptoms especially among managers/qualified professionals, while household physical activity and occupational physical activity were consistently associated with higher depressive symptoms across the different occupations. Transportation physical activity was associated with elevated depressive symptoms among clerks/service workers and qualified manual workers. The association between the domains of physical activity and depressive symptoms is dependent on the type of occupation. Future research exploring the association between domain-based physical activity and depression should account for the type of occupation.

Persistent inequalities in health care services utilisation in Brazil (1998–2019)

BackgroundOne of the primary objectives of the Brazilian health care system is to improve the health and well-being of all citizens. Since the establishment of the Unified Health System/Sistema Único de Saúde (SUS) in 1988, Brazil has made strides towards reducing inequalities in health care services utilisation. However, there are currently no comprehensive and up-to-date studies focused on inequalities in both curative and preventive health care services utilisation.MethodsWe evaluated data from the National Household Sample Survey and the Brazilian National Health Survey, which are two nationally representative studies that include findings from 1998, 2003, and 2008 and 2013 and 2019, respectively. We calculated Erreygers-corrected Concentration Indices (CInds) to evaluate the magnitude of socioeconomic-related inequalities associated with five indicators of health care services utilisation, including physician visits, hospital admissions, surgical procedures, Pap smears, and mammograms. The main factors associated with these inequalities were identified via a decomposition analysis of the calculated CInds.ResultsWhile the results of our analysis revealed persistent inequalities in health care services utilisation that favour the wealthy, we found that the overall magnitude of these inequalities decreased over time. The largest inequalities were observed in the utilisation of preventive care services (Pap smears and mammograms) and services available in the poorest regions of the country. Except for admissions for labour and delivery, our findings revealed that wealthier individuals were more likely to utilise hospital services; this represents a change from findings reported in previous years. Private health insurance coverage and individual socioeconomic status are significantly associated with inequalities in health care services utilisation throughout Brazil.ConclusionsCollectively, our findings suggest that we must continue to monitor potential inequalities in health care service utilisation to determine whether Brazilian policy objectives focused on improved health outcomes for all will ultimately be achieved.