OBJECTIVES: To assess the extent of gender inequalities in health status and health services utilization among adolescents and adults in Brazil. METHODS: A representative sample of 217 248 individuals from 15 to 64 years of age was obtained from the National Household Sample Survey (Pesquisa Nacional de Amostras por Domicílios, PNAD) conducted in 1998 by the Brazilian Institute of Geography and Statistics and funded by the Ministry of Health. The study focused on three outcome variables (self-assessed health status, medical visits, and hospitalizations (except childbirth)) and five exposure variables (age, gender, ethnicity, income, and education). Unconditional logistic regression and Mantel-Haenszel stratified analysis was employed. Prevalence rate ratios were calculated for each stratum. Confidence intervals were calculated using the Taylor series, with a 95% confidence interval (95% CI). RESULTS: Women were more likely to report fair or poor health than men (odds ratio (OR) = 1.33; 95% CI: 1.31-1.35). Gender disparities were significant for all ages, household income brackets, and education levels, and were always unfavorable to women (1.17 < OR < 1.44). Gender disparities for medical visits were higher for those in good health; tended to fall as age, income, and education increased; and were always favorable for women (1.12 < OR < 2.06). Gender disparities in hospitalization rates decreased with age, varied according to income and education level in each age group, and were always favorable for women (1.16 < OR < 1.66). CONCLUSIONS: The difference in self-reported health status for men and women became even greater after adjusting for socioeconomic variables, suggesting that poorer women have more pronounced, relative differences than men do. The impact of structural determinants, such as education and income, is considerably smaller than the social construct of gender, although the former are more important predictors. Women use health services more often than men do, which is consistent with their health needs. However, medical visit rates show an inverse relationship to health care needs, suggesting an inequitable access to outpatient care, mainly preventive care.

OBJETIVOS: Evaluar la magnitud de las desigualdades de género con relación al estado de salud y la utilización de los servicios de salud en adolescentes y adultos en Brasil. MÉTODOS: Se tomó una muestra representativa compuesta por 217 248 personas de 15 a 64 años de edad a partir de la Encuesta Nacional de Muestras de Hogares (Pesquisa Nacional de Amostras por Domicílios, PNAD), realizada por el Instituto Brasileño de Geografía y Estadísticas en 1998 con fondos del Ministerio de Salud. El estudio se concentró en tres variables de resultado (estado autoevaluado de salud, consultas médicas y hospitalizaciones (excepto para el parto)) y cinco variables de exposición (edad, sexo, origen étnico, ingresos y educación). Se utilizó la regresión logística incondicional y el análisis estratificado de Mantel-Haenszel. Se calcularon las razones de las tasas de prevalencia para cada estrato. Los intervalos de confianza se calcularon mediante la serie de Taylor, con un intervalo de confianza de 95% (IC95%). RESULTADOS: Las mujeres tuvieron una mayor probabilidad de considerar su salud regular o mala que los hombres (razón de posibilidades [odds ratio, OR]) = 1,33; IC95%: 1,31 a 1,35). Las desigualdades según el sexo fueron significativas para todas las edades y todos los niveles de ingresos del hogar y de educación, siempre desfavorables para las mujeres (1,17 < OR < 1,44). Las desigualdades de género con relación a las consultas médicas fueron mayores en personas con buena salud; presentaron una tendencia a disminuir a medida que aumentaban la edad, los ingresos y el nivel educacional; y siempre estuvieron a favor de las mujeres (1,12 < OR < 2,06). Las desigualdades de género en cuanto a las tasas de hospitalización disminuyeron con la edad, fluctuaron de acuerdo con los ingresos y el nivel educacional en cada grupo de edad y siempre estuvieron a favor de las mujeres (1,16 < OR < 1,66). CONCLUSIONES: Las diferencias en cuanto al estado autoinformado de salud en hombres y mujeres aumentaron después de ajustar por las variables socioeconómicas, lo que indica que las mujeres más pobres enfrentan mayores diferencias relativas que los hombres. El impacto de los factores determinantes estructurales, como la educación y los ingresos, es considerablemente menor que los elementos teóricos sociales de género, aunque los primeros son predictores más importantes. Las mujeres utilizan los servicios de salud con mayor frecuencia que los hombres, lo que es coherente con sus mayores necesidades de atención sanitaria. No obstante, las tasas de consultas médicas muestran una relación inversa con respecto a las necesidades de atención sanitaria, lo que indica que no es equitativo el acceso a la atención ambulatoria, especialmente a la atención preventiva.

Com o envelhecimento da população brasileira torna-se cada vez mais importante conhecer a prevalência das doenças crônicas. Essas doenças constituem-se em forte demanda aos serviços de saúde. Foram utilizados os dados da amostra da PNAD/98. Analisou-se o conjunto de doenças crônicas auto-referidas, empregou-se a razão de prevalência e razão de odds ratios com intervalo de confiança de 95% para verificar a presença de associações. Comprovou-se o aumento da prevalência das doenças crônicas com o aumento da idade; padronizando-se a idade identificou-se um gradiente de redução da prevalência com aumento da escolaridade e da renda. Observou-se maior prevalência entre mulheres e entre os que não possuíam plano de saúde. A presença de doença crônica estava associada à má avaliação do estado de saúde e de restrição de atividade. A utilização dos serviços de saúde foi de 1,8 vezes entre os portadores de doenças crônicas; com um consumo significativamente maior do número médio de consultas. Não se verificou diferença significante do número médio de consultas médicas por estrato de renda. Entre os portadores de doença crônica não houve diferença significativa do número médio de consultas entre usuários do SUS e de planos privados de saúde.

The prevalence and the distribution of chronic diseases became of overwhelming importance with the ageing process of Brazilian population. These diseases are responsible by an increased demand of health services. It was analyzed the data from the sample of the Health Supplement of PNAD/98 (National Household Sample Survey). It was used the data from all self reported chronic diseases by sociodemographic variables and health services consumption. It was employed prevalence ratios and odds ratios, with 95% confidence interval to evaluate the presence of possible associations. As expected it was observed an increase of chronic diseases prevalence with age; and a decrease with educational and income level. It was found higher rates of chronic diseases in women and in the group without access to private health insurance. Consumption of health services was 1.8 fold for the chronic diseases group. It was not found an association between the mean number of medical visits and income level, although it was observed a clear differential in hospitalization rates, with higher rates of hospitalization in the higher income brackets. It was not also found differences of the mean number of medical visits between the owners of private health insurance and the users of the Brazilian National Health System (SUS).

Com o envelhecimento da população brasileira torna-se cada vez mais importante conhecer a prevalência das doenças crônicas. Essas doenças constituem-se em forte demanda aos serviços de saúde. Foram utilizados os dados da amostra da PNAD/98. Analisou-se o conjunto de doenças crônicas auto-referidas, empregou-se a razão de prevalência e razão de odds ratios com intervalo de confiança de 95% para verificar a presença de associações. Comprovou-se o aumento da prevalência das doenças crônicas com o aumento da idade; padronizando-se a idade identificou-se um gradiente de redução da prevalência com aumento da escolaridade e da renda. Observou-se maior prevalência entre mulheres e entre os que não possuíam plano de saúde. A presença de doença crônica estava associada à má avaliação do estado de saúde e de restrição de atividade. A utilização dos serviços de saúde foi de 1,8 vezes entre os portadores de doenças crônicas; com um consumo significativamente maior do número médio de consultas. Não se verificou diferença significante do número médio de consultas médicas por estrato de renda. Entre os portadores de doença crônica não houve diferença significativa do número médio de consultas entre usuários do SUS e de planos privados de saúde.

The prevalence and the distribution of chronic diseases became of overwhelming importance with the ageing process of Brazilian population. These diseases are responsible by an increased demand of health services. It was analyzed the data from the sample of the Health Supplement of PNAD/98 (National Household Sample Survey). It was used the data from all self reported chronic diseases by sociodemographic variables and health services consumption. It was employed prevalence ratios and odds ratios, with 95% confidence interval to evaluate the presence of possible associations. As expected it was observed an increase of chronic diseases prevalence with age; and a decrease with educational and income level. It was found higher rates of chronic diseases in women and in the group without access to private health insurance. Consumption of health services was 1.8 fold for the chronic diseases group. It was not found an association between the mean number of medical visits and income level, although it was observed a clear differential in hospitalization rates, with higher rates of hospitalization in the higher income brackets. It was not also found differences of the mean number of medical visits between the owners of private health insurance and the users of the Brazilian National Health System (SUS).