Comparison of risk and protective factors for chronic diseases in the population with and without health insurance in the Brazilian capitals, 2011

Health insurance status, lifestyle choices and the presence of non-communicable diseases: a systematic review

BACKGROUND

Although health insurance (HI) has effectively mitigated healthcare financial burdens, its contribution to healthy lifestyle choices and the presence of non-communicable diseases (NCDs) is not well established. We aimed to systematically review the existing evidence on the effect of HI on healthy lifestyle choices and NCDs.

METHODS

A systematic review was conducted across PubMed, Medline, Embase, Cochrane Library and CINAHLComplet@EBSCOhost from inception until 30 September 2022, capturing studies that reported the effect of HI on healthy lifestyle and NCDs. A narrative synthesis of the studies was done. The review concluded both longitudinal and cross-sectional studies. A critical appraisal checklist for survey-based studies and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies were used for the quality assessment.

RESULT

Twenty-four studies met the inclusion criteria. HI was associated with the propensity to engage in physical activities (6/11 studies), consume healthy diets (4/7 studies), not to smoke (5/11 studies) or take alcohol (5/10 studies). Six (of nine) studies showed that HI coverage was associated with a lowered prevalence of NCDs.

CONCLUSION

This evidence suggests that HI is beneficial. More reports showed that it propitiated a healthy lifestyle and was associated with a reduced prevalence of NCDs.

Factors associated with chronic kidney disease: epidemiological survey of the National Health Survey

OBJECTIVE

To identify the prevalence of chronic kidney disease (CKD) self-reported in Brazil and characterize the factors associated with it.

METHODS

This study was a cross-sectional health survey with a household-based, the National Health Survey, performed in 2013. The outcome in the present study was the prevalence of CKD. The groups of explanatory variables were socio-demographic characteristics, lifestyles, chronic self-reported diseases, anthropometry, and health evaluation. The prevalence of CKD, e their 95% respective confidence interval were estimated, univariate analysis and the multiple logistic regression model were calculated, and remained the variables statistically significant (p < 0.05).

RESULTS

It noticed that 1.42% (95%CI 1.33 - 1.52) of the 60,202 interviewees self-reported CKD. The OR increased progressively with age, being 2.68 among the elderly with 65 years or more (95%CI 1.75 - 4.09). Having health plans with OR = 1.51 (95%CI 1.28 - 1.78), as well as smoking, hypertension and high cholesterol and poor self-reported health with OR = 1.75 (95%CI 1.45 - 2.12), OR = 1.20 (95%CI 1.02 - 1.42), OR = 1.83 (95%CI 1.56 - 2.15), OR = 4.70 (95%CI 3.75 - 5.88), respectively, showed a higher chance of CKD.

CONCLUSIONS

The associated variables were increasing age, health plan coverage, smoking, hypertension, hypercholesterolemia, and regular or poor health status. The knowledge of CKD prevalence in Brazil and risk and protection factors are essential for disease prevention and the establishment of supporting public health policies.

Co-occurrence of Smoking and Unhealthy Diet in the Brazilian Adult Population

Background

Smoking and an inadequate diet are behavioral risk factors that contribute to the majority of deaths and disabilities caused by noncommunicable diseases.

Objectives

To estimate the prevalence of the co-occurrence of smoking and inadequate diet and identify associated factors in adults.

Methods

A cross-sectional population-based study was conducted with a sample of 28,950 Brazilian adults (18 to 59 years old). Data were obtained from Sistema de Vigilância por Inquérito Telefônico (Vigitel [Brazilian Health Surveillance Telephone Survey]) in 2014. Independent associations were investigated using Poisson hierarchical regression analysis with 5% significance level.

Results

The prevalence of the co-occurrence of smoking and unhealthy eating was 8.6% (95% CI: 7.9-9.3) and was higher among individuals residing in the southern region of the country than in those living in the central western region (PR = 1.50; 95% CI: 1.18-1.89), those with no private health insurance (PR = 1.14; 95% CI: 1.03-1.25), those who drank alcohol abusively (binge drinkers) (PR = 3.22; 95% CI: 2.70-3.85) and those who self-rated their health as fair (PR = 1.65; 95% CI: 1.36-1.99) or poor/very poor (PR = 1.70; 95% CI: 1.18-2.44). The prevalence of both factors was lower among individuals residing in the northeastern region of the country, women, individuals with brown skin color, those with a spouse, the more educated ones and those with overweight or obesity.

Conclusion

The more vulnerable segments to the co-occurrence of the risk factors studied were men residing in the southern region of the country, individuals with a lower socioeconomic status and those who reported binge drinking. Interventions addressing multiple behavioral risk factors adapted to specific contexts could have a greater impact on the Brazilian population.

Indicators of chronic noncommunicable diseases in women of reproductive age that are beneficiaries and non-beneficiaries of Bolsa Família

OBJECTIVE

To evaluate the prevalence of noncommunicable disease (NCD) indicators, including laboratory tests, in the population of Brazilian women of reproductive age, according to whether or not they receive the Bolsa Família (BF) benefit.

METHODS

A total of 3,131 women aged 18 to 49 years old who participated in the National Health Survey (Pesquisa Nacional de Saúde ) laboratory examination sub-sample were considered. We compared indicators among women of reproductive age (18 to 49 years old) who reported receiving BF or not, and calculated prevalence and confidence intervals, using Pearson's χ2.

RESULTS

Women of reproductive age who were beneficiaries of BF had worse health outcomes, such as a greater occurrence of being overweight (33.5%) and obese (26.9%) (p < 0.001), having hypertension (13.4% versus 4.4%, p < 0.001), used more tobacco (11.2% versus 8.2%, p = 0.029), and perceived their health as worse (6.2% versus 2.4%, p < 0.001).

CONCLUSION

Several NCD indicators were worse among women of childbearing age who were beneficiaries of BF. It should be emphasized that this is not a causal relationship, with BF being a marker of inequalities among women. The benefit has been directed to the population with greater health needs, and seeks to reduce inequities.

Indicators of chronic noncommunicable diseases in women of reproductive age that are beneficiaries and non-beneficiaries of Bolsa Família

OBJECTIVE

To evaluate the prevalence of noncommunicable disease (NCD) indicators, including laboratory tests, in the population of Brazilian women of reproductive age, according to whether or not they receive the Bolsa Família (BF) benefit.

METHODS

A total of 3,131 women aged 18 to 49 years old who participated in the National Health Survey (Pesquisa Nacional de Saúde ) laboratory examination sub-sample were considered. We compared indicators among women of reproductive age (18 to 49 years old) who reported receiving BF or not, and calculated prevalence and confidence intervals, using Pearson's χ2.

RESULTS

Women of reproductive age who were beneficiaries of BF had worse health outcomes, such as a greater occurrence of being overweight (33.5%) and obese (26.9%) (p < 0.001), having hypertension (13.4% versus 4.4%, p < 0.001), used more tobacco (11.2% versus 8.2%, p = 0.029), and perceived their health as worse (6.2% versus 2.4%, p < 0.001).

CONCLUSION

Several NCD indicators were worse among women of childbearing age who were beneficiaries of BF. It should be emphasized that this is not a causal relationship, with BF being a marker of inequalities among women. The benefit has been directed to the population with greater health needs, and seeks to reduce inequities.

Fatores associados à prática de Atividade Física na população brasileira - Vigitel 2013

RESUMO O artigo teve como objetivo analisar a associação entre a Atividade Física no Tempo Livre e as variáveis selecionadas nas capitais brasileiras. Foram analisadas informações do Sistema Nacional de Vigilância de Doenças Crônicas por Inquérito Telefônico, referentes ao ano de 2013, em uma amostra de 54 mil adultos nas capitais do Brasil. As Razões de Prevalências foram ajustadas segundo idade, sexo e escolaridade, utilizando-se regressão de Poisson com seus Intervalos de Confiança a 95%. A prevalência da prática de Atividade Física no Tempo Livre foi de 33,8% (IC95%: 33,0-34,6), sendo maior entre homens (41,2%) (IC95%: 39,9-42,6) do que entre mulheres (27,4%) (IC95%: 26,5-28,3). Ser mais jovem, do sexo masculino, com maior escolaridade, da cor branca, possuir plano de saúde, não fumar e consumir o recomendado de frutas e hortaliças aumentaram a chance da prática da Atividade Física no Tempo Livre. Observou-se ainda que eutróficos e sobrepeso são mais ativos, obesos praticam menos Atividade Física. Conclui-se que a Atividade Física é benéfica à saúde, tornando-se importante investir em políticas públicas de promoção à saúde, visando criar oportunidades de inclusão social e equidade em saúde.

Health care in adults with self-reported hypertension in Brazil according to the National Health Survey, 2013

OBJECTIVE

To describe health care indicators in adults with self-reported hypertension in Brazil, according to socio-demographic characteristics.

METHODS

Data from the National Health Survey 2013, a cross-sectional population-based study, about health care of self-reported hypertension and health services were used. Prevalence and 95% confidence intervals (95%CI) were calculated for sex, age, race/color skin and schooling levels, representing Brazil and major regions.

RESULTS

Hypertension was reported by 21.4% (95%CI 20.8 - 22.0) of respondents, being higher in women and in people without instruction and incomplete middle school. Among these, 45.9% (95%CI 44.0 - 47.7) reported having received medical care for the last time in a basic health unit; 81.4% (95%CI 80.1 - 82.7) reported taking medication for high blood pressure; and 92.0% (95%CI 91.2 - 92.8) reported having taken all requested complementary examinations.

CONCLUSION

It is important to know the coverage and access to health services for the care of patients with hypertension, in order to improve care quality and reduce identified inequalities.

[Health behaviors and preventive tests in adults with and without health insurance in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil, 2003-2010]

This study analyzed indicators for health behaviors and use of preventive services in two probabilistic samples of adults, one in 2003 (n = 13,757) and the other in 2010 (n = 12,983), with and without private health insurance in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. After adjusting for demographic variables, temporal variation, and source of care, there was a reduction in smoking prevalence, similar between individuals with and without private health insurance, from 2003 to 2010. During this same period the prevalence of excessive alcohol intake and sedentary lifestyle increased in both groups; with the same magnitude, there was a decrease in the prevalence of leisure-time physical activity. No changes were observed in the prevalence of blood pressure measurement, but the prevalence of cholesterol testing, mammogram, and Pap smear increased more sharply in individuals without health insurance.

Substance misuse and sexual function in adolescents with chronic diseases

Objective:

To evaluate alcohol/tobacco and/or illicit drug misuse in Chronic Diseases (CDs).

Methods:

A cross-sectional study with 220 CDs adolescents and 110 healthy controls including: demographic/anthropometric data; puberty markers; modified questionnaire evaluating sexual function, alcohol/smoking/illicit drug misuse and bullying; and the physician-conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk.

Results:

The frequencies of alcohol/tobacco and/or illicit drug use were similar in both groups (30% vs. 34%, p=0.529), likewise the frequencies of bullying (42% vs. 41%, p=0.905). Further analysis solely in CDs patients that used alcohol/tobacco/illicit drug versus those that did not use showed that the median current age [15 (11–18) vs. 14 (10–18) years, p <0.0001] and education years [9 (5–14) vs. 8 (3–12) years, p <0.0001] were significant higher in substance use group. The frequencies of Tanner 5 (p <0.0001), menarche (p <0.0001) and spermarche (p=0.001) were also significantly higher in patients with CDs that used alcohol/tobacco/illicit, likewise sexual activity (23% vs. 3%, p <0.0001). A trend of a low frequency of drug therapy was observed in patients that used substances (70% vs. 82%, p=0.051). A positive correlation was observed between CRAFFT score and current age in CD patients (p=0.005, r=+0.189) and controls (p=0.018, r=+0.226).

Conclusions:

A later age was evidenced in CDs patients that reported licit/ilicit drug misuse. In CDs adolescent, substance use was more likely to have sexual intercourse. Our study reinforces that these patients should be systematically screened by pediatricians for drug related health behavioral patterns.

Associations between noncommunicable disease risk factors, race, education, and health insurance status among women of reproductive age in Brazil - 2011

BACKGROUND

Noncommunicable disease (NCD) risk factors increase the risk of adverse reproductive health outcomes and are becoming increasingly common in Brazil.

METHODS

We analyzed VIGITEL 2011 telephone survey data for 13,745 Brazilian women aged 18-44 years in a probabilistic sample from 26 Brazilian state capitals and the Federal District. We examined associations between NCD risk factors (fruit and vegetable intake, leisure time physical activity, alcohol consumption, smoking status, BMI and hypertension status) and race, education, and insurance using chi-square tests and multivariable logistic regression models, estimating the average marginal effects to produce adjusted relative risk ratios (aRRs). Analyses were conducted using SAS 9.3 survey procedures and weighted to reflect population estimates.

RESULTS

Women with less than a college education were more likely to report physical inactivity (adjusted relative risk (aRR) and 95% confidence interval = 1.1 (1.1-1.2)), smoking (aRR = 1.7 (1.3-2.2)), and self-reported diagnoses of hypertension (aRR = 2.0 (1.6-2.5)) compared to women with a college education or greater. Similarly, women without health insurance were more likely to report physical inactivity (aRR = 1.1 (1.1-1.2)), smoking (aRR = 1.4 (1.1-1.8)), and self-reported diagnoses of hypertension aRR = 1.4 (1.1-1.7)) compared to women with health insurance. Less variation was found by race and NCD risk factors.

CONCLUSION

Targeted public health strategies and policies are needed to increase healthcare access and decrease educational and racial disparities in NCD risk factors among women of reproductive age in Brazil.