[Health insurance users: self-reported morbidity and access to preventive tests according to a telephone survey, Brazil, 2008]

Social inequalities in access to cancer screening and early detection: A population-based study in the city of São Paulo, Brazil

OBJECTIVE

This study monitors trends in access to cancer screening, focusing on mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA), assessing the magnitude of inequality in the city of São Paulo from 2003 to 2015 according to education level.

METHOD

This is a cross-sectional population-based study conducted with data from the 2003, 2008, and 2015 editions of the Health Survey of the City of São Paulo (ISA-Capital). Outcome variables were the proportion of mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA) tests according to the protocols. Inequality was measured by education level according to years of study. For static analysis, Poisson regression was used to estimate proportion ratios.

RESULTS

The proportion of Pap smears remained stationary at a high level (>89%) throughout the study period, while access to mammography and PSA tests significantly increased in the 2003‒2015 period. The present results indicate inequalities in access to cancer screening due to education, and being more expressive for mammography and PSA tests. However, this inequality significantly decreased over the period analyzed comparing the most educated individuals with those with the lowest educational level. In addition, an increase in the proportion of tests performed in the Brazilian Unified Health System was identified, especially for mammography and PSA tests, in the period 2003‒2015.

CONCLUSIONS

The inequalities observed in the access to preventive exams were influenced by the level of education. The offer of exams was expanded, more significantly for mammography and PSA, especially among the less educated group.

Analysis of demand and access to services in the last two weeks previous to the National Health Survey 2013 and 2019

OBJECTIVE

Compare the demand and use of health services between 2013 and 2019, and analyze the associated sociodemographic and health variables in 2019.

METHODS

Cross-sectional study with data from the National Health Survey (PNS) 2013 and 2019. The prevalence and 95% confidence intervals (95% CI) for the demand and use of health services were estimated. In 2019, the differences in the indicators were analyzed according to sociodemographic variables and the crude and adjusted by sex and age prevalence ratios (RP) were estimated.

RESULTS

There was an increase of 22% in the demand for health care in the last two weeks, going from 15.3% (95%CI 15.0-15.7) in 2013 to 18.6% (95%CI 18.3-19.0) in 2019. There was a reduction in use in the last two weeks, from 97% (95%CI 96.6-97.4) in 2013 to 86.1% (95%CI 85.4-86.8) in 2019, which was observed for most Federation Units. In 2019, the demand for care was greater among women, the elderly, those with high schooling, individuals with health insurance and poor self-rated health. They obtained greater access to health services in the fifteen days prior to the survey: men, children or adolescents up to 17 years of age, people with health insurance and poor health self-assessment.

CONCLUSION

The demand for health services has grown and reduced access in the last 15 days between 2013 and 2019. These differences may have been exacerbated by the austerity measures implemented in the country.

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

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Health insurance coverage in Brazil: analyzing data from the National Health Survey, 2013 and 2019

This paper aimed to describe health insurance coverage in Brazil. Data from the 2013 and 2019 editions of the National Health Survey (PNS) were analyzed. The medical or dental health insurance coverage was analyzed according to demographic and socioeconomic characteristics, work status, urban/rural area, and Federation Unit. Coverage of medical or dental health insurance was 27.9% (95% CI: 27.1-28.8) for 2013 and 28.5% (95% CI: 27.8-29.2) for 2019. The results show coverage is still concentrated in large urban centers, in the Southeast and South, among those with better socioeconomic status and some formal employment. In 2019, only 30.7% of formal workers reported the monthly payment is made directly to the providers, while 72.7% of informal workers reported this information. About 92% of medical health insurance covers hospitalization, and almost 20% of women with health insurance are not covered for labor. Only 11.7% of women aged between 15 and 44 are covered for childbirth by health insurance. The results show the health insurance coverage is still quite unequal, reinforcing the Unified Health System (SUS) importance for the Brazilian population.

Determinants of mental health and abuse of psychoactive substances associated with tobacco use. A case-control study

This study aimed to estimate the strength of association among smokers with variables regarding mental health, family functionality, and use of other psychoactive substances. This is a case-control observational study developed from March to November 2016. The study was conducted in a Brazilian Midwest municipality with 646 subjects, of which 323 were cases. In the model, the case group comprised subjects with a certain degree of tobacco dependence. The control group included subjects that were not exposed to tobacco. Concerning tobacco use time, the mean exposure of the case group was 25.65 years. In the multiple logistic regression analysis model the following were positively associated: non-white skin color (p = 0.002); years of study ≤ 8 (p < 0.001); having children (p < 0.001); informal work (p = 0.024); not having a health plan (p < 0.001); high family dysfunction (p = 0.007); AUDIT ≥ 8 (p < 0.001); depression (p < 0.001); having illicit drug in lifetime (p < 0.001); living with other people (p = 0.003) and no religion (p = 0.001). This study reinforces the vulnerability of smokers, associating variables correlated to the field of mental health, and innovates by discussing the influence of family relationships on nicotinic dependence.

Private Health Care Coverage in the Brazilian population, according to the 2013 Brazilian National Health Survey

This study aims to present the percentages of the Brazilian population holding health insurance plans, itemized by social-demographic characteristics, based on the data of the National Health Survey carried out in 2013, and to compare this information with the administrative data of the National Supplementary Health Agency for the same year. Data from the National Health Survey, and from the Beneficiaries Information System of the National Health Agency for the year 2013, were used. The percentage of people having a health plan was described according to stratification for: all of Brazil, urban/rural, Brazilian official Regions, Brazilian States and state capitals, gender, age group, level of schooling, position in the workforce, ethnic classification, and self-assessed state of health. Results include the following: The percentage of people saying they had some health plan in Brazil was 27.9% (CI 95%: 27.1-28.8). A significant difference was found relating to level of schooling - the percentage being highest for those who stated they had complete secondary education (68.8% CI 95%: 67.2-70.4) and for those who said they were currently in work (32.5% CI 95%: 31.5-33.5). The increase in health plan coverage in the Brazilian population reflects the improvement of the suply of employment and the growth in the country's economy.

Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil

OBJECTIVE

To assess whether sex, education level, and health insurance affect the use of health services among the adult Brazilian population with chronic noncommunicable diseases (NCD).

METHODS

Data from a cross-sectional survey were analyzed, the National Health Survey (PNS). Frequency of use of services in the population that referred at least one NCD were compared with the frequency from a population that did not report NCD, according to sex, education level, health insurance, and NCD number (1, 2, 3, 4, or more). The prevalence and prevalence ratios were calculated crude and adjusted for sex, age, region, and 95% confidence intervals.

RESULTS

The presence of a noncommunicable disease was associated with increase in hospitalizations in the last 12 months, in 1.7 times (95%CI 1.53-1.9). Failing to perform usual activities in the last two weeks for health reasons was 3.1 times higher in NCD carriers (95%CI 2.78-3.46); while the prevalence of medical consultation in the last 12 months was 1.26 times higher (95%CI 1.24-1.28). NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level.

CONCLUSIONS

NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level.

Utilization of public and private health services by the population of Belo Horizonte

OBJECTIVE

To analyze the differences in health services utilization by users of Brazilian Unified Health System (SUS) and beneficiaries of Supplemental Health (SH).

METHODS

A total of 288 adult subjects, residing in Belo Horizonte, who participated in the VIGITEL telephone survey in 2009, composed the sample, whose variables were analyzed according to the classification as users of SUS or beneficiaries of SH. Prevalence Ratios (PR), adjusted for sex, age and schooling, were calculated to evaluate differences between groups.

RESULTS

Need and demand for health services were similar between groups, and users of SUS were less successful in obtaining service (PR = 0.78; p = 0.027). Most participants in both groups evaluated the health care received as very good/good without significant differences (72.1% for SUS, 84.0% for SH; p > 0.05).

CONCLUSION

Although there are differences in the utilization of health services in Belo Horizonte, the service obtained is well rated by both users of SUS and health plans.

Socioeconomic and regional inequalities of pap smear coverage

Objectives To identify socioeconomic and regional inequalities of pap smear coverage in the state of Rio Grande do Sul. Methods An ecological study based on data of the 2011-2012 national health information system to estimate the annual coverage of pap smears for the overall female population of the state and for women without private health insurance. We estimated annual pap smear coverage according to the Municipal Social Vulnerability Index and health macro-regions and regions of the state. Results The percentage of women without private health insurance ranged from 38.1% to 94.2% in the health regions. Pap smear coverage was 17.3% for the overall female population and 23.8% for women without private health insurance. Pap smear coverage was higher in more socially vulnerable municipalities and regions with a higher percentage of women with private health insurance. Conclusions The prevalence of private health insurance should be considered in studies that address the coverage of the Brazilian Unified Health System (SUS).

Equity of access to Pap smears: population-based study in Campinas, São Paulo, Brazil

OBJECTIVE

To determine the prevalence of the Papanicolaou exam among women aged 20 to 59 years in the city of Campinas (state of São Paulo, Brazil) and to analyze associations between this test and affiliation to private health insurance plans as well as socioeconomic/demographic variables and health-related behavior.

METHOD

To do so, a population-based, cross-sectional study was carried out. Statistical analyses took the study design into account.

RESULTS

Despite the significant socioeconomic differences between women with and without private health plans, no differences between these groups were found regarding having been submitted to the Papanicolaou test. In fact no differences were found as to socioeconomic and health variables analyzed. Among all variables analyzed, only marital status was significantly associated with having undergone the test. The Brazilian public health system accounted for 55.7% of the exams.

CONCLUSION

The present findings indicate social equity in the city of Campinas regarding the preventive exam for cervical cancer in the age group studied.

[Mammogram screening for breast cancer and associated factors in the South of Brazil: a based-population survey]

The purpose of this study was to identify factors associated with annual mammogram screening in women 40 to 69 years of age in Florianópolis, Santa Catarina State, Brazil. Data were obtained from two population studies with independent samples, one with adult women and the other with elderly women, in 2009-2010. Prevalence rates for annual mammogram screening were estimated by crude and adjusted Poisson regression. Overall prevalence of annual mammograms in adult women was 43.5% (95%CI: 38.8-48.2) and was higher in women with private health insurance. In elderly women, prevalence was 38.3% (95%CI: 34.0-42.6), with the following associated factors: marital status (married/with partner), schooling (> 5 years), and highest income quartile. Mammogram screening should be independent of socioeconomic status and age in order to reduce mortality from breast cancer.

Analysis of care given to patients with hypertension in Belo Horizonte, according to telephone survey

OBJECTIVE: To examine the care given to patients with hypertension in the Brazilian public and private health services in the population of Belo Horizonte, Minas Gerais. METHODS: Telephone interviews were conducted in a sample of hypertensive adults in the year 2009, in Belo Horizonte (n = 100). We compared the care provided to hypertensive users of the Unified Health System (SUS) and of the Supplementary Health (SS), using the χ2 test or Fisher's exact test. The prevalence ratio was calculated by the Poisson regression model, adjusted for the variables age, education and skin color. RESULTS: In the descriptive analysis, hypertensive users of private health plans had a higher frequency of physician referral and greater blood pressure control. Unified Health System users were the ones who participated in health promotion groups the most. The acquisition of antihypertensive medications by beneficiaries of private health insurance was more frequent in private pharmacies, and in Health Centers among users of the Unified Health System. The differences disappeared when adjusting the variables for age, race and education. There was no difference regarding the guidance received for a change of habits, or regarding the incorporation of these healthy practices promotion by hypertensive patients. CONCLUSION: A healthier diet, the practice of physical activity, and the non-use of alcohol and tobacco have been incorporated by hypertensive patients, whether owning private health insurance or not. Promotion practices, proper use of medication a clinical follow-up are important for the control of blood pressure levels.

Need, enabling, predisposing, and behavioral determinants of access to preventative care in Argentina: analysis of the national survey of risk factors

INTRODUCTION

Health care utilization is an important step to disease management, providing opportunities for prevention and treatment. Anderson's Health Behavior Model has defined utilization by need, predisposing, and enabling determinants. We hypothesize that need, predisposing, and enabling, highlighting behavioral factors are associated with utilization in Argentina.

METHODS

We performed a logistic regression analysis of the 2005 and 2009 Argentinean Survey of Risk Factors, a cohort of 41,392 and 34,732 individuals, to explore the association between need, enabling, predisposing, and behavioral factors to blood pressure measurement in the last year.

RESULTS

In the 2005 cohort, blood pressure measurement was associated with perception of health, insurance coverage, basic needs met, and income. Additionally, female sex, civil state, household type, older age groups, education, and alcohol use were associated with utilization. The 2009 cohort showed similar associations with only minor differences between the models.

CONCLUSIONS

We explored the association between utilization of clinical preventive services with need, enabling, predisposing, and behavioral factors. While predisposing and need determinants are associated with utilization, enabling factors such as insurance coverage provides an area for public intervention. These are important findings where policies should be focused to improve utilization of preventive services in Argentina.