Vaccination coverage and use of the Brazilian Health System for vaccination against influenza and pneumonia in adults and elderly with self-reported diabetes, municipality of São Paulo, 2003, 2008 and 2015

Monteiro, Camila Nascimento; Gianini, Reinaldo José; Stopa, Sheila Rizzato; Segri, Neuber José; Barros, Marilisa Berti de Azevedo; Cesar, Chester Luiz Galvão; Goldbaum, Moisés

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 27 (2) • 2018 • https://doi.org/10.5123/S1679-49742018000200006 copy

Vaccination coverage and use of the Brazilian Health System for vaccination against influenza and pneumonia in adults and elderly with self-reported diabetes, municipality of São Paulo, 2003, 2008 and 2015^* * This article is derived from the doctoral thesis entitled 'Access, use and equity in health care services in São Paulo - populational household surveys', defended by Camila Nascimento Monteiro at the Postgraduate Program in Preventive Medicine, University of São Paulo Faculty of Health Sciences; 2016.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to estimate the vaccination coverage against influenza and pneumonia and to analyze the utilization of Brazilian National Health System-SUS for vaccination in adults and elderly with self-reported diabetes in São Paulo, Brazil, in 2003, 2008 and 2015.

Methods:

Cross-sectional studies with data from the ISA-Capital (population-based household surveys).

Results:

3,357, 3,271 and 4,043 were interviewed in 2003, 2008 and 2015; the prevalence of diabetes mellitus were 5.0% (2003), 6.4% (2008) and 7.7% (2015); fewer than half of people with diabetes, vaccinated against influenza (47.2%) and pneumonia (17.9%) in 2003, with a small increase in 2015 (59.2% and 26.1%, respectively); the majority of people who are vaccinated against influenza and pneumonia used SUS, 88.7% (2003) and 97.2% (2015) for influenza; 84.7% (2003) and 94.5% (2015) for pneumonia, without difference among age, sex, education level and ethnicity.

Conclusion:

despite the low vaccination coverage against influenza and pneumonia in the population with diabetes mellitus since 2003 the utilization of SUS to vaccination has been progressively expanding.

Keywords:
Vaccination; Brazilian National Health System; Cross-sectional studies; Diabetes Mellitus

Variables	2003				2008				2015
Variables	n	Prevalence (%)	95%CI^a	p value	n	Prevalence (%)	95%CI^a	p value	n	Prevalence (%)	95%CI^a	p value
Age group (in years)				<0.001				<0.001				<0.001
20-59	19	2.6	1.7;3.9		44	3.7	2.8;4.9		110	4.4	3.5;5.4
≥60	151	17.4	14.7;20.3		199	20.0	17.3;23.1		238	22.5	20.0;25.2
Sex				0.628				0.084				0.003
Male	76	4.4	2.9;6.6		91	5.4	4.1;7.1		125	5.4	4.5;6.6
Female	94	5.3	4.0;7.1		152	7.2	5.9;8.8		227	7.8	6.7;9.2
Education level ^b (in years of schooling)				0.008				0.004				<0.001
0-3	70	11.1	8.5;14.5		80	14.7	11.4;18.7		73	15.9	12.3;20.5
4-7	62	5.9	4.1;8.5		94	9.7	7.5;12.5		163	10.1	84.0;12.1
8-11	22	2.6	1.5;4.5		53	5.1	3.6;7.1		64	4.1	3.3;5.1
≥12	13	3.7	1.7;7.8		14	2.7	1.5;4.8		50	4.3	3.0;6.1
Ethnicity/skin color ^b				0.386				0.463				0.271
White	117	3.4	2.6;4.4		185	4.6	3.7;5.8		65	4.6	3.4;6.3
Black	14	4.4	1.9;9.6		17	4.0	3.0;5.3		11	3.0	1.5;5.7
Brown	38	2.4	1.5;3.9		85	4.3	3.7;5.2		35	3.5	2.5;4.9
Total	170	5.0	3.9;6.2		246	6.4	5.4;7.5		348	7.7	6.8;8.7

Variables	2003				2008				2015
Variables	n	Prevalence (%)	95%CI^a	p value	n	Prevalence (%)	95%CI^a	p value	n	Prevalence (%)	95%CI^a	p value
Influenza
Age group (in years)				<0.001				<0.001				<0.001
20-59	2	14.8	59.2;95.8		7	17.9	8.9;32.7		44	38.7	28.4;50.1
≥60	106	70.7	61.8;78.2		138	66.9	59.1;73.9		184	77.2	68.4;84.1
Sex				0.336				0.785				0.860
Male	46	39.9	27.6;53.6		58	43.9	30.9;57.9		80	58.6	48.8;67.7
Female	62	50.5	35.7;65.1		87	41.6	32.7;51.1		148	59.6	50.9;67.8
Education level ^b (in years of schooling)				0.196				0.028				0.450
0-3	51	50.5	33.2;67.7		51	53.3	40.7;65.5		52	68.8	55.6;79.5
4-7	39	48.6	33.6;63.9		63	51.9	37.9;65.5		106	58.6	49.6;67.1
8-11	9	22.8	10.1;43.6		27	35.5	21.6;52.3		36	51.2	37.5;64.8
≥12	7	55.8	27.9;80.4		3	15.0	4.4;40.2		33	61.7	40.2;79.4
Ethnicity/skin color ^b				0.351				0.178				0.249
White	69	48.5	35.4;61.8		93	42.2	32.9;52.5		38	48.3	33.7;63.1
Black	8	24.2	6.8;58.2		9	22.2	10.0;42.2		7	48.9	21.9;76.5
Brown	27	43.5	25.3;63.6		36	46.7	32.8;61.4		24	65.5	47.0;80.3
Total	108	47.2	37.6;57.0		145	43.0	35.6;50.7		228	59.2	52.2;65.7
Pneumonia
Age group (in years)				0.017				<0.001	-	-	-	0.002
20-59	1	4.5	0.6;27.8		1	1.8	0.2;11.6		19	16.2	9.7;25.8
≥60	36	29.3	20.3;40.3		46	24.3	17.9;32.2		82	35.2	27.0;44.3
Sex				0.844				0.890				0.527
Male	16	18.4	8.2;36.3		17	13.5	7.5;23.0		31	23.9	16.0;34.2
Female	21	17.0	10.6;26.3		30	12.8	8.0;19.7		70	27.3	20.5;35.4
Education level ^b (in years of schooling)			0.256				0.095				0.655
0-3	15	18.4	9.8;32.1		14	13.2	8.1;20.9		20	29.9	18.1;45.0
4-7	17	26.4	12.9;46.4		21	19.5	11.2;31.8		44	23.7	16.8;32.5
8-11	3	10.4	2.7;33.1		8	6.6	3.1;13.3		18	23.5	14.2;36.2
≥12	2	7.3	1.5;34.4		4	19.6	6.6;45.8		18	31.6	17.6;50.0
Ethnicity/skin color ^b				0.281				0.075				0.098
White	24	17.1	11.1;25.5		33	15.3	10.2;22.4		20	21.6	13.0;33.5
Black	3	6.9	1.5;26.0		3	6.9	2.1;19.8		2	15.1	3.5;46.4
Brown	9	26.6	9.3;55.9		8	7.1	3.1;15.5		13	38.1	23.3;55.3
Total	37	17.9	11.1;27.6		47	13.2	9.4;18.3		101	26.1	20.1;33.0

Use of health services	2003			2008			2015
Use of health services	n	%	95%CI^a	n	%	95%CI^a	n	%	95%CI^a
Type of health service used for vaccination against influenza ^b
Brazilian National Health System (SUS)	92	88,7	78,9;94,3	131	80,7	68,1;89,1	224	97,2	94,2;99,1
Not SUS	13	11,3	5,7;21,1	14	19,3	10,9;31,9	5	2,3	0,9;5,8
Type of health service used for vaccination against pneumonia ^c
SUS	35	84,7	55,1;96,2	39	76,2	57,1;88,5	96	94,5	87,0;97,8
Not SUS	2	15,3	3,8;44,9	8	23,8	11,5;42,9	5	5,5	2,2;13,0

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Camila Nascimento Monteiro - Hospital Israelita Albert Einstein, Av. Brigadeiro Faria Lima, 1188, Jardim Paulistano, São Paulo, SP, Brazil. CEP: 01451-001. E-mail: c.nascimentomonteiro@gmail.com