Sources of access to medication and its use in the rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: a cross-sectional population-based study

Bertoldi, Andrea Dâmaso; Silveira, Marysabel Pinto Telis; Machado, Adriana Kramer Fiala; Xavier, Mariana Otero; Martins, Rafaela Costa

doi:10.1590/S1679-49742021000100005

person Andrea Dâmaso Bertoldi

schoolUniversidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil

0000-0002-4680-3197

person Marysabel Pinto Telis Silveira

schoolUniversidade Federal de Pelotas, Departamento de Fisiologia e Farmacologia, Pelotas, RS, Brazil

0000-0002-6453-8534

person Adriana Kramer Fiala Machado

schoolUniversidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil

0000-0002-6800-1064

person Mariana Otero Xavier

schoolUniversidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil

0000-0001-8791-3520

person Rafaela Costa Martins

schoolUniversidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil

0000-0003-3538-7228

Correspondence:Rafaela Costa Martins - Rua Marechal Deodoro, No. 1160, 3º piso, Centro, Pelotas, RS, Brazil. Postcode: 96020-220.
E-mail:
rafamartins1@gmail.com

Associate Editor

Taís Freire Galvão - 0000-0003-2072-4834

groupsAuthors’ contributions

Bertoldi AD, Silveira MPT, Machado AKF, Xavier MO and Martins RC took part in the concept and planning of the study, data interpretation and drafting the article. Machado AKF, Xavier MO and Martins RC took part in data acquisition. Machado AKF and Martins RC performed the statistical analyses. All the authors contributed to the preliminary versions of the manuscript, critically reviewed its intellectual contents, approved the final version and are responsible for all aspects thereof.

Variables	Total		Medication use
Variables	n	%	n	% (95%CI^a)
Sex
Male	734	48.3	349	47.2 (40.8;53.7)
Female	785	51.7	485	61.6 (54.9;67.8)
Age (years)
18-39	515	34.0	166	32.0 (27.1;37.3)
40-59	593	39.2	332	55.7 (50.9;60.4)
≥60	411	26.8	336	81.9 (71.1;89.2)
Self-reported skin color
White	1.296	85.1	714	54.9 (48.9;60.7)
Non-white	223	14.9	120	53.4 (41.4;65.0)
Lives with partner
No	443	29.2	228	51.0 (44.6;57.3)
Yes	1.076	70.8	606	56.2 (49.4;62.7)
Schooling
No schooling/incomplete elementary education	996	66.1	609	60.7 (52.2;68.7)
Complete elementary education/incomplete high school education	233	15.4	92	39.2 (31.0;48.1)
Complete high school education/incomplete higher education	213	14.0	89	41.9 (36.0;48.1)
Complete higher education or above	67	4.5	36	53.4 (42.4;64.0)
Economic classification
A/B	301	20.0	170	56.5 (49.9;62.9)
C	814	53.7	436	53.4 (46.2;60.4)
D/E	388	26.3	221	56.3 (47.5;64.8)
Current work situation
Not working	613	40.5	420	68.3 (62.0;74.0)
Working	906	59.5	414	45.3 (39.3;51.6)
Self-perceived health
Very good/good	964	64.1	404	41.6 (36.0;47.5)
Regular	461	30.4	349	75.6 (64.2;84.3)
Poor/very poor	82	5.5	72	87.7 (78.7;93.2)
Number of chronic diseases
None	631	41.8	162	25.6 (21.0;30.8)
1 - 2	614	40.2	426	69.2 (63.0;74.7)
3 or more	274	18.0	246	89.6 (72.5;96.6)
Registered with Family Health Strategy
No	423	28.6	212	49.9 (37.5;62.3)
Yes	1.070	71.4	608	56.6 (52.2;60.9)
Distance from home to pharmacy
Easy to access	941	62.8	497	52.4 (46.2;58.6)
Hard to access	563	37.2	325	57.8 (50.0;65.1)
Distance from home to nearest primary healthcare center
Far, but easy to access	179	11.7	94	51.8 (42.7;60.8)
Far and hard to access	121	7.9	66	54.8 (45.4;63.8)
Close and easy to access	1.107	74.3	606	54.5 (48.3;60.5)
Close, but hard to access	92	6.1	56	61.0 (47.4;73.2)
Total	1,519	100.0	834	54.7 (48.7;60.5)

Variables	Medication use
	Crude analysis		Adjusted analysis
	PR^a (95%CI^b)	p-value^c	PRa (95%CI^b)	p-value^c
Sex		<0.001		<0.001
Male	1.00		1.00
Female	1.30 (1.18;1.45)		1.23 (1.12;1.34)
Age (years)		<0.001^d		<0.001d
18-39	1.00		1.00
40-59	1.74 (1.54;1.97)		1.74 (1.54;1.97)
≥60	2.56 (2.23;2.84)		2.36 (2.05;2.73)
Self-reported skin color		0.800		0.483
White	1.00		1.00
Non-white	0.97 (0.79;1.20)		1.07 (0.89;1.28)
Schooling		<0.001^d		0.623
No schooling/incomplete elementary	1.00		1.00
Complete elementary/incomplete high school	0.65 (0.51;0.82)		0.92 (0.73;1.17)
Complete high school/incomplete higher education	0.69 (0.60;0.80)		0.92 (0.80;1.07)
Complete higher education or above	0.88 (0.70;1.11)		0.98 (0.75;1.27)
Lives with partner		0.079		0.016
No	0.91 (0.81;1.01)		0.88 (0.80;0.98)
Yes	1.00		1.00
Economic classification		0.586		0.667
A/B	1.00		1.00
C	0.94 (0.80;1.12)		0.94 (0.80;1.11)
D/E	1.00 (0.83;1.20)		0.93 (0.80;1.09)
Current work situation		<0.001		0.005
Not working	1.00		1.00
Working	0.66 (0.59;0.75)		0.82 (0.71;0.94)
Self-perceived health		<0.001d		<0.001
Very good/good	1.00		1.00
Regular	1.82 (1.62;2.04)		1.29 (1.17;1.42)
Poor/very poor	2.11 (1.85;2.39)		1.29 (1.14;1.46)
Number of chronic diseases		<0.001^d		<0.001^d
None	1.00		1.00
1 - 2	2.71 (2.31;3.16)		2.23 (1.92;2.58)
3 or more	3.50 (2.98;4.12)		2.37 (2.03;2.77)
Registered with Family Health Strategy		0.292		0.270
No	1.00		1.00
Yes	1.13 (0.89;1.44)		1.15 (0.89;1.47)
Distance from home to pharmacy		0.120		0.222
Easy to access	1.00		1.00
Hard to access	1.10 (0.97;1.25)		1.06 (0.96;1.17)
Distance from home to nearest primary healthcare center	0.384		0.459	0,459
Far, but easy to access	1.00		1.00
Far and hard to access	1.06 (0.86;1.30)		0.98 (0.83;1.15)
Close and easy to access	1.05 (0.90;1.22)		1.08 (0.95;1.23)
Close, but hard to access	1.18 (0.98;1.42)		1.02 (0.86;1.21)

Variables	Sources of access to medication
	SUS^b	Private establishment	Mixed (SUS and private establishment)
	(n=116)	(n=380)	(n=333)
	%(IC95%^c)	%(IC95%^c)	%(IC95%^c)
Sex
Male	17.3 (13.1;22.5)	49.3 (43.0;55.7)	33.3 (27.4;39.9)
Female	11.6 (8.5; 15.8)	43.3 (36.7; 50.2)	45.0 (40.0; 50.2)
Age (years)
18-39	17.4 (12.0;24.6)	57.9 (48.0;67.2)	24.7 (18.3;32.4)
40-59	14.5 (11.4;18.2)	43.7 (38.0;49.6)	41.8 (36.1;47.8)
≥60	11.9 (8.4;16.5)	41.9 (34.4;49.9)	46.2 (38.5;54.1)
Self-reported skin color
White	12.5 (9.8;15.8)	47.8 (42.2;53.5)	39.7 (34.5;45.0)
Non-white	22.9 (16.4;31.1)	33.9 (24.5;44.9)	43.2 (35.4;51.3)
Lives with partner
No	15.5 (10.9;21.7)	40.3 (35.1;45.8)	44.1 (39.3;49.1)
Yes	13.4 (10.6;16.9)	47.9 (41.6;54.2)	38.7 (33.2;44.4)
Schooling
No schooling/incomplete elementary	14.0 (10.9;17.9)	41.3 (35.1;47.7)	44.8 (38.8;50.9)
Complete elementary/incomplete high school	12.1 (5.8;23.3)	54.8 (40.5;68.4)	33.1 (21.8;46.8)
Complete high school /incomplete higher education	18.0 (10.2;29.9)	53.3 (42.4;64.0)	28.6 (18.6;41.4)
Complete higher education or above	9.2 (3.0;24.9)	79.1 (64.2;88.8)	11.7 (5.4;23.5)
Economic classification
A/B	9.9 (6.0;15.9)	60.3 (53.3;67.0)	29.8 (22.3;38.7)
C	12.3 (9.1;16.5)	43.3 (36.0;50.9)	44.3 (37.6;51.3)
D/E	20.8 (15.3;27.7)	37.9 (30.8;45.7)	41.3 (35.6;47.1)
Current work situation
Not working	12.4 (8.9;17.1)	36.5 (30.9;42.5)	51.1 (45.4;56.9)
Working	15.7 (12.3;19.7)	55.5 (49.5;61.3)	28.9 (23.4;35.1)
Self-perceived health
Very good/good	17.2 (14.1;20.9)	50.3 (44.4;56.2)	32.5 (27.2;38.3)
Regular	10.1 (6.7;14.9)	42.9 (36.1;50.0)	47.0 (39.9;54.1)
Poor/very poor	13.2 (5.7;27.8)	35.0 (21.0;52.3)	51.8 (39.2;64.1)
Number of chronic diseases
None	16.2 (10.6;24.1)	69.6 (59.0;78.5)	14.2 (8.3;23.1)
1 - 2	15.3 (12.0;19.2)	45.2 (39.2;51.4)	39.5 (33.7;45.7)
3 or more	10.3 (6.5;16.0)	31.1 (23.7;39.6)	58.6 (50.7;66.2)
Registered with Family Health Strategy
No	12.1 (7.8;18.3)	54.0 (46.5;61.4)	33.9 (30.1;37.9)
Yes	14.7 (11.6;18.4)	42.6 (36.6;48.9)	42.7 (36.6;49.0)
Distance from home to pharmacy
Easy to access	15.0 (11.5;19.4)	45.4 (38.8;52.0)	39.6 (33.6;46.0)
Hard to access	12.7 (9.4;16.9)	46.4 (40.6;52.3)	40.9 (35.7;46.4)
Distance from home to nearest Primary Healthcare Center
Far, but easy to access	10.7 (5.5;19.7)	49.7 (37.5;61.9)	39.6 (29.2;51.1)
Far and hard to access	12.4 (6.5;22.6)	52.7 (39.8;65.3)	34.9 (25.1;46.1)
Close and easy to access	15.0 (11.9;18.8)	43.7 (38.6;49.0)	41.2 (35.8;46.9)
Close, but hard to access	13.1 (7.3;22.3)	49.9 (32.2;67.7)	37.0 (23.4;53.1)
Total	14.0 (11.2;17.4)	45.8 (40.3;51.4)	40.2 (35.5;45.0)

Variables	Adjusted analysis
Variables	PR^a (IC95%^b)	p-value^c	PR^a (IC95%^b)	p-value^c
Sex		0.040		0.055
Male	1.00		1.00
Female	0.67 (0.46;0.98)		0.68 (0.46;1.01)
Age (years)		0.178		0.441
18-39	1.00		1.00
40-59	0.83 (0.54;1.28)		0.84 (0.54;1.30)
≥60	0.68 (0.45;1.05)		0.72 (0.43;1.20)
Self-reported skin color		0.004		0.004
White	1.00		1.00
Non-white	1.83 (1.24;2.71)		1.82 (1.24;2.66)
Schooling		0.612		0.197
No schooling/incomplete elementary	1.00		1.00
Complete elementary/incomplete high school	0.86 (0.41;1.81)		0.82 (0.39;1.74)
Complete high school /incomplete higher education	1.29 (0.70;2.39)		1.65 (0.91;2.97)
Complete higher education or above	0.66 (0.23;1.88)		1.09 (0.33;3.64)
Lives with partner		0.405		0.777
No	1.15 (0.81;1.64)		1.05 (0.73;1.52)
Yes	1.00		1.00
Economic classification		0.010e		0.004e
A/B	1.00		1.00
C	1.25 (0.71;2.19)		1.34 (0.76;2.37)
D/E	2.11 (1.21;3.70)		2.48 (1.30;4.76)
Current work situation		0.176		0.192
Not working	1.00		1.00
Working	1.26 (0.89;1.78)		1.30 (0.87;1.94)
Self-perceived health		0.053		0.013
Very good/good	1.00		1.00
Regular	0.59 (0.38;0.91)		0.53 (0.35;0.80)
Poor/very poor	0.77 (0.38;1.56)		0.69 (0.33;1.44)
Number of chronic diseases		0.153		0.254
None	1.00		1.00
1 - 2	0.94 (0.58;1.53)		0.99 (0.67;1.47)
3 or more	0.63 (0.37;1.10)		0.68 (0.39;1.20)
Registered with Family Health Strategy		0.391		0.368
No	1.00		1.00
Yes	1.21 (0.77;1.92)		1.21 (0.79;1.84)
Distance from home to pharmacy		0.318		0.312
Easy to access	1.00		1.00
Hard to access	0.84 (0.60;1.19)		0.83 (0.57;1.20)
Distance from home to nearest primary healthcare center	0.777		0.952	0,952
Far, but easy to access	1.00		1.00
Far and hard to access	1.16 (0.54;2.50)		1.08 (0.53;2.20)
Close and easy to access	1.41 (0.70;2.84)		1.14 (0.61;2.13)
Close, but hard to access	1.22 (0.55;2.72)		0.96 (0.46;1.99)

[TFN14] a) 95%CI: 95% confidence interval.

Sources of access to medication and its use in the rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: a cross-sectional population-based study*

Sources of access to medication and its use in the rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: a cross-sectional population-based study^*