Social determinants and access to health services in patients with COVID-19: a cross-sectional study

OBJECTIVE

To verify the association between social determinants of health and access to health services for COVID-19 patients.

METHOD

Analytical, cross-sectional study, carried out in three states in the Northeast of Brazil (Ceará, Maranhão and Pernambuco), with 968 patients, using questionnaires with sociodemographic data, determinants and the Primary Care Assessment Tool, adapted to the reality of COVID-19, with 58 items, classified as high (score ≥ 6.6) and low (score < 6.6), whose high value reveals better standards of access to health services. The Chi-square test was used for comparative analysis.

RESULTS

There was a significant difference (p < 0.05) between the domains of the instrument and the following determinants: age, skin color, body mass index, origin, schooling, employment, services close to home, first service, income and means of transport.

CONCLUSION

Access to health services for people with COVID-19 was associated with various determinants, including individual, behavioural and social ones, correlated with the structural and organizational aspects of the health services offered by the three states of Northeastern Brazil.

Absenteeism of diabetics to appointments with an endocrinologist and its relationship with access to health services

Objective: To analyze the association between absenteeism and access to specialized consultations for diabetics, in the Unified Health System (SUS) in Espírito Santo (ES). Methods: Cross-sectional study conducted using primary and secondary data with 472 diabetics ≥ 18 years old scheduled in consultation with endocrinologist in the System of Regulation Centers of ES. The variables of the dimensions of access - availability, financial viability, and acceptability - were used to estimate the association with absenteeism. Logistic regression was used for the crude and adjusted analyses. Results: An association was found between absenteeism of diabetics and the variables living less than 10 km from the provider (OR: 1.81; 95%CI: 1.16 - 2.82, p = 0.01), need for transportation (OR: 4.89; 95%CI: 2.54 - 9.42, p < 0.001), and having financial expenses to attend the appointment (OR: 2.06; 95%CI: 1.23 - 3.44; p = 0.01). Conclusion: The main barriers of access to health services that contribute to the high prevalence of absenteeism from appointments with endocrinologists can be understood as a proxy for the socioeconomic status of diabetics and show close relationship with the social determinants of health.