<i>Inequidades en la atención de salud y acceso a servicios de salud entre adultos con hipertensión arterial autoinformada:</i> Encuesta Nacional de Salud

Malta, Deborah Carvalho; Gomes, Crizian Saar; Stopa, Sheila Rizzato; Andrade, Fabiana Martins Dias de; Prates, Elton Junio Sady; Oliveira, Patrícia Pereira Vasconcelos de; Ferreira, Sheila Aparecida Massardi; Pereira, Cimar Azeredo

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ARTICLE • Cad. Saúde Pública 38 (Suppl 1) • 2022 • https://doi.org/10.1590/0102-311Xe00125421 copiar

Inequidades en la atención de salud y acceso a servicios de salud entre adultos con hipertensión arterial autoinformada: Encuesta Nacional de Salud

Autoría SCIMAGO INSTITUTIONS RANKINGS

Este estudio comparó indicadores de atención y acceso a servicios de salud por parte de los adultos que se autodeclararon hipertensos en 2013 y 2019, analizando estos indicadores según género, grupo de edad, nivel de educación y raza/color. Estudio analítico con datos de la Encuesta Nacional de Salud (PNS) realizada en 2013 y 2019 en Brasil. Se compararon indicadores de atención y acceso a los servicios sanitarios de los individuos con hipertensión en ambas encuestas. Para 2019, estos indicadores se analizaron según características sociodemográficas. Este estudio estimó las proporciones, la razón de prevalencia (RP) y los respectivos intervalos de 95% de confianza (IC95%). En total, 60.202 individuos fueron evaluados en 2013 y 88.531 en 2019, de los cuales 24,4% declaró ser hipertenso en 2013 y 23,9% en 2019. Las mujeres recibieron mas atención médica por hipertensión en el último año (RP = 1,07; IC95%: 1,04; 1,11) y la última consulta médica en unidad básica de salud (RP = 1,11; IC95%: 1,05; 1,17) que los hombres. En cuanto raza/color, los negros tuvieron más hospitalizaciones por hipertensión o alguna complicación (RP = 1,2; IC95%: 1,05; 1,38) y un grado intenso o muy intenso de limitación para realizar actividades diarias (RP = 1,37; IC95%: 1,06; 1,76). En 2019, se evidenciaron desigualdades y se observaron peores indicadores en hombres, los negros, con baja educación y la edad joven. Las inversiones en el Sistema Único de Salud brasileño, así como políticas públicas y acciones son esenciales para reducir las desigualdades, promover la atención sanitaria.

Palabras-clave:
Hipertensión; Disparidades en el Estado de Salud; Enfermedad Crónica; Factores de Riesgo; Aténcion Primaria de Salud

Indicators	Total		Gender
	Total		Male (A)		Female (B)		Adjusted PR (B/A)	95%CI
	%	95%CI	%	95%CI	%	95%CI
Prescribed medication	95.4	94.9; 95.8	938	92.9; 94.5	96.5	95.9; 97.0	1.02	1.01; 1.03
Use of medication in the previous two weeks	86.9	86.1; 87.7	831	81.7; 84.5	89.6	88.6; 90.5	1.06	1.04; 1.08
At least one medication from the “We Have a Popular Pharmacy Here” program	45.1	43.6; 46.5	437	41.7; 45.7	46.0	44.3; 47.7	1.03	0.98; 1.08
Received medical care for hypertension within the last year	72.2	71.1; 73.3	68.9	67.3; 70.5	74.5	73.1; 75.8	1.07	1.04; 1.11
Had the last physician appointment at an UBS	45.8	44.4; 47.2	41.8	39.7; 43.9	48.5	46.9; 50.2	1.11	1.05; 1.17
Had an appointment with the same physician as in the previous appointments	51.9	50.6; 53.3	52.3	50.3; 54.3	51.7	49.8; 53.5	0.99	0.94; 1.05
Appointments with a specialist	49.0	47.6; 50.4	49.5	47.4; 51.5	48.6	46.8; 50.5	1.01	0.96; 1.07
Referral for appoint with a specialist	79.1	76.8; 81.1	78.6	75.0; 81.8	79.3	76.5; 82.0	1.01	0.96; 1.06
Hospitalization for hypertension or some complication	15.0	14.2; 15.9	13.6	12.4; 15.0	15.9	14.8; 17.1	1.14	1.01; 1.28
Intense or very intense degree of limitation in performing daily activities	3.0	2.7; 3.4	3.1	2.5; 3.7	3.0	2.6; 3.5	0.93	0.73; 1.17

Indicator	Age Group (years)
	18-29 (A)		30-59 (B)		≥ 60 (C)		Adjusted PR B/A	95%CI	Adjusted PR (C/A)	95%CI
	%	95%CI	%	95%CI	%	95%CI
Prescribed medication	68.4	61.6; 74.5	93.3	92.4; 94.1	98.8	98.4; 99.0	1.35	1.23; 1.49	1.43	1.30; 1.57
Use of medication in the previous two weeks	39.3	31.9; 47.2	81.9	80.6; 83.2	94.3	93.6; 94.9	2.05	1.69; 2.49	2.34	1.93; 2.85
At least one medication from the program “We Have a Popular Pharmacy Here”	21.1	14.0; 30.6	45.7	43.3; 48.0	45.1	43.5; 46.7	2.16	1.46; 3.20	2.08	1.41; 3.08
Received medical care for hypertension within the last year	62.9	54.9; 70.3	71.1	69.5; 72.8	73.7	72.3; 75.0	1.11	0.98; 1.25	1.13	1.00; 1.27
Had the last physician appointment at UBS	47.1	38.6; 55.7	45.5	43.6; 47.4	46.0	44.3; 47.8	0.95	0.80; 1.14	0.92	0.76; 1.10
Had appointment with the same physician as in the previous appointments	37.6	29.4; 46.6	49.6	47.6; 51.5	54.9	53.2; 56.7	1.29	1.02; 1.62	1.42	1.13; 1.79
Appointments with a specialist	64.2	48.3; 77.8	75.4	71.7; 78.8	83.4	80.6; 85.9	1.17	0.93; 1.47	1.31	1.04; 1.64
Referral for appointment with a specialist	35.8	28.0; 44.5	46.4	44.3; 48.5	52.1	50.4; 53.9	1.27	1.02; 1.58	1.47	1.18; 1.83
Hospitalization for hypertension or some complication	13.0	8.3; 19.9	14.1	12.9; 15.5	16.0	14.8; 17.2	1.02	0.65; 1.58	1.07	0.69; 1.68
Intense or very intense degree of limitation in performing daily activities	2.9	1.2; 6.8	3.1	2.6; 3.8	2.9	2.5; 3.4	0.92	0.37; 2.26	0.70	0.29; 1.72

Indicators	Level of education
	No education or incomplete primary school (A)		Complete primary school and incomplete high school (B)		Complete high school and incomplete higher education (C)		Complete higher education (D)		Adjusted PR (B/A)	95%CI	Adjusted PR (C/A)	95%CI	Adjusted PR (D/A)	95%CI
	%	95%CI	%	95%CI	%	95%CI	%	95%CI
Prescribed medication	96.4	95.8; 96.8	93.3	91.5; 94.7	93.4	92.0; 94.5	96.8	95.7; 97.7	0.99	0.97; 1.01	0.99	0.98; 1.01	1.01	1.00; 1.02
Use of medication in the previous two weeks	89.2	88.2; 90.1	84.4	81.8; 86.8	82.2	80.0; 84.2	88.4	86.4; 90.2	1.00	0.97; 1.02	0.97	0.94; 1.00	1.01	0.98; 1.03
At least one medication from the “We Have a Popular Pharmacy Here” program	47.9	46.1; 49.7	50.4	46.7; 54.1	43.0	40.2; 45.9	30.9	27.8; 34.2	1.07	0.99; 1.16	0.93	0.86; 1.00	0.70	0.62; 0.79
Received medical care for hypertension within the last year	73.7	72.3; 75.1	73.0	69.7; 76.1	69.6	67.3; 71.9	69.2	66.1; 72.1	0.99	0.95; 1.04	0.94	0.91; 0.98	0.91	0.87; 0.96
Had the last physician’s appointment at UBS	57.2	55.5; 58.9	44.4	40.8; 48.1	35.1	32.3; 38.0	15.4	12.9; 18.4	0.86	0.80; 0.93	0.77	0.72; 0.84	0.52	0.44; 0.62
Had an appointment with the same physician as in the previous appointments	49.9	48.2; 51.7	51.0	47.4; 54.6	52.1	49.3; 54.8	61.9	58.4; 65.2	1.01	0.94; 1.09	0.99	0.93; 1.06	1.06	0.98; 1.14
Appointments with a specialist	42.7	40.9; 44.5	48.6	45.0; 52.2	53.4	50.7; 56.0	70.1	66.7; 73.2	1.00	0.92; 1.10	1.03	0.97; 1.10	1.09	1.00; 1.18
Referral for appointment with a specialist	78.1	75.2; 80.8	75.8	69.4; 81.3	79.9	75.2; 83.9	87.1	81.2; 91.3	1.11	1.02; 1.20	1.14	1.07; 1.23	1.27	1.18; 1.37
Hospitalization for hypertension or some complication	17.2	16.0; 18.5	13.9	11.7; 16.6	12.4	10.8; 14.3	11.0	9.0; 13.4	0.83	0.69; 1.00	0.77	0.64; 0.91	0.71	0.56; 0.89
Intense or very intense degree of limitation in performing daily activities	4.1	3.6; 4.7	3.0	2.1; 4.2	1.6	1.2; 2.1	1.0	0.5; 1.8	0.69	0.47; 1.03	0.38	0.26; 0.54	0.25	0.13; 0.48

Indicator	Ethnicity
	White (A)		Black (B)		Mixed-race (C)		Adjusted PR (B/A)	95%IC	Adjusted PR (C/A)	95%CI
	%	95%CI	%	95%CI	%	95%CI
Prescribed medication	96.2	95.5; 96.8	95.0	93.5; 96.2	94.5	93.7; 95.2	1.00	0.98; 1.01	1.00	0.98; 1.01
Use of medication in the previous two weeks	88.5	87.2; 89.6	86.7	84.6; 88.6	85.3	84.1; 86.5	0.99	0.97; 1.01	1.00	0.98; 1.03
At least one medication from the “We Have a Popular Pharmacy Here” program	44.8	42.9; 46.8	46.3	43.0; 49.7	44.8	42.8; 46.9	0.94	0.89; 1.00	0.97	0.89; 1.06
Received medical care for hypertension within the last year	71.5	69.9; 73.1	74.7	71.9; 77.3	72.1	70.5; 73.7	1.01	0.98; 1.04	1.05	1.01; 1.09
Had the last physician appointment at UBS	39.4	37.3; 41.6	51.9	48.6; 55.2	50.7	48.9; 52.5	1.01	0.96; 1.07	1.06	0.98; 1.14
Had appointment with the same physician as in the previous appointments	56.7	54.6; 58.7	48.8	45.4; 52.2	48.2	46.3; 50.2	0.92	0.87; 0.97	0.93	0.85; 1.00
Appointments with a specialist	54.6	52.5; 56.6	47.9	44.6; 51.3	43.4	41.5; 45.3	0.96	0.91; 1.01	0.94	0.87; 1.02
Referral for appointment with a specialist	82.9	79.7; 85.7	75.4	68.9; 80.9	76.7	73.3; 79.7	0.92	0.88; 0.97	1.02	0.94; 1.09
Hospitalization for hypertension or some complication	13.2	11.9; 14.6	15.7	13.5; 18.2	16.8	15.4; 18.3	1.20	1.05; 1.38	1.14	0.95; 1.36
Intense or very intense degree of limitation in performing daily activities	2.2	1.8; 2.7	3.5	2.7; 4.6	3.6	3.1; 4.3	1.37	1.06; 1.76	1.38	0.99; 1.94

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[1] Correspondence
D. C. Malta Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, 5º andar, Belo Horizonte, MG 30130-100, Brasil. dcmalta@uol.com.br