Comparison of risk and protective factors for chronic diseases in the population with and without health insurance in the Brazilian capitals, 2011

Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata

doi:10.1590/1809-4503201400050019

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Revista Brasileira de Epidemiologia

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Original Articles • Rev. bras. epidemiol. 17 (suppl 1) • 2014 • https://doi.org/10.1590/1809-4503201400050019 copy

Comparison of risk and protective factors for chronic diseases in the population with and without health insurance in the Brazilian capitals, 2011

Authorship SCIMAGO INSTITUTIONS RANKINGS

INTRODUCTION:

The article compares the risk and protective factors for Non-communicable Diseases (NCD), referred morbidity and access to preventive examinations in the population with and without health insurance in all Brazilian State capitals.

METHODS:

The study population consists of adults (≥ 18 years old) living in households with landlines in 26 Brazilian State capitals and the Federal District. Estimates of selected variables are presented according to possession of health plans ("Yes" or "No") and sex. A post-stratification was performed according to age, gender and education in both populations, and prevalence ratios were calculated, adjusted for age and sex between people with and without health insurance for the risk and protective factors for NCDs.

RESULTS:

A total of 54,099 people at the age of 18 or older were evaluated, 47.4% of them were beneficiaries of health plans. The coverage of health insurance tends to increase with age and level of education. Compared to non-beneficiaries of health plans, beneficiaries were more likely to have protective factors, such as healthy eating, physical activity, coverage tests, such as mammography and Pap test, and lower prevalence of risk factors such as smoking, physical inactivity, poor health assessment and hypertension. Alcohol abuse, consumption of excessively fat meats, overweight, obesity and diabetes were not associated with the variable possession of health insurance. When controlled by education, individuals who have health insurance generally have better indicators.

CONCLUSION:

This information is important to establish measures for reducing differences among people with and without health insurance.

Chronic Disease; Health plans; Smoking; Papanicolaou smear; Mammography; Population surveys

Capital	Having a health plan		Total	Coverage of health plan
Capital	No	Yes	Total	%	95%CI
Aracaju	810	1191	2001	47.9	45.19 – 50.68
Belém	890	1148	2038	46.2	43.47 – 49.01
Belo Horizonte	758	1247	2005	57.6	55.02 – 60.15
Boa Vista	1270	747	2017	26.1	23.61 – 28.69
Campo Grande	1006	990	1996	45.6	43.01 – 48.16
Cuiabá	898	1102	2000	49.3	46.64 – 52.03
Curitiba	838	1161	1999	56.0	53.49 – 58.49
Florianópolis	695	1305	2000	58.4	55.70 – 61.08
Fortaleza	940	1062	2002	42.8	40.10 – 45.46
Goiânia	908	1091	1999	51.1	48.53 – 53.66
João Pessoa	906	1094	2000	40.2	37.39 – 42.93
Macapá	1058	938	1996	29.5	25.10 – 33.88
Maceió	917	1084	2001	40.1	37.27 – 42.89
Manaus	1176	838	2014	35.1	32.47 – 37.65
Natal	882	1118	2000	45.1	42.28 – 47.87
Palmas	920	1081	2001	42.1	39.23 – 44.92
Porto Alegre	828	1185	2013	54.2	51.60 – 56.90
Porto Velho	1036	963	1999	37.1	34.51 – 39.75
Recife	918	1094	2012	46.2	43.50 – 48.94
Rio Branco	1186	815	2001	29.7	27.23 – 32.17
Rio de Janeiro	854	1145	1999	52.6	50.00 – 55.29
Salvador	1083	915	1998	38.2	35.76 – 40.71
São Luís	1208	800	2008	30.8	28.38 – 33.28
São Paulo	907	1092	1999	50.3	47.76 – 52.84
Teresina	917	1083	2000	41.0	38.29 – 43.77
Vitória	678	1322	2000	63.5	60.92 – 66.05
Distrito Federal	987	1014	2001	40.8	38.33 – 43.37
Total	25474	28625	54099	47.4	46.57 – 48.25

Variables	OR	95%CI
Age group
18 – 24	1.00
25 – 34	1.03	0.91 – 1.17
35 – 44	1.27	1.12 – 1.44
45 – 54	1.63	1.43 – 1.86
55 – 64	1.95	1.69 – 2.25
65 – 90	3.39	2.92 – 3.94
Schooling
0 – 8	1.00
9 – 11	2.82	2.57 – 3.10
12 – 20	11.58	10.36 – 12.95

Indicators	Having a health plan				OR_adj	95%CI
	Yes		No
	Proportion	95%CI	Proportion	95%CI
Smoking
Smoker	10.07	9.29 – 10.85	16.37	15.37 – 17.36	0.66	0.59 – 0.74
Former smoker	21.30	20.33 – 22.27	22.82	21.83 – 23.81	0.99	0.91 – 1.09
Smokes 20 or more cigarettes	2.99	2.54 – 3.44	4.93	4.33 – 5.52	0.70	0.57 – 0.86
Passive smoker in the household	9.83	9.07 – 10.58	12.67	11.83 – 13.51	0.82	0.73 – 0.93
Passive smoker at work	9.29	8.57 – 10.01	12.93	12.11 – 13.75	0.82	0.73 – 0.93
Consumption
FVG regularly	39.98	38.85 – 41.12	27.94	26.88 – 29.00	1.36	1.26 – 1.47
FVG recommended	25.90	24.90 – 26.91	18.36	17.42 – 19.29	1.24	1.13 – 1.35
Meat with excessive fat	29.73	28.63 – 30.83	34.93	33.75 – 36.10	0.92	0.85 – 1.00
Whole milk	51.00	49.82 – 52.17	60.29	59.13 – 61.45	0.75	0.70 – 0.81
Soft drink on five days or more	25.86	24.78 – 26.95	29.02	27.87 – 30.17	0.91	0.83 – 0.99
Beans on five days or more	63.88	62.78 – 64.98	70.96	69.95 – 71.98	0.92	0.85 – 0.98
Physical activity
In free time	37.59	36.45 – 38.72	26.18	25.15 – 27.22	1.41	1.30 – 1.52
Commuting	12.37	11.53 – 13.21	18.60	17.62 – 19.57	0.66	0.59 – 0.73
In the household	30.11	29.05 – 31.18	44.47	43.29 – 45.65	0.63	0.59 – 0.68
At work	36.89	35.74 – 38.04	45.29	44.08 – 46.49	0.79	0.73 – 0.85
Leisure or transportation	27.49	26.45 – 28.54	28.90	27.80 – 29.99	0.88	0.82 – 0.96
Inactive	15.94	15.10 – 16.79	13.97	13.16 – 14.79	1.14	1.03 – 1.26
Alcohol consumption
Abusive	16.54	15.65 – 17.44	16.50	15.59 – 17.41	0.94	0.85 – 1.03
Driving after drinking	7.16	6.57 – 7.75	3.60	3.19 – 4.01	1.45	1.24 – 1.70
Health
Excess weight	49.56	48.34 – 50.78	48.62	47.34 – 49.89	1.05	0.97 – 1.13
Obesity	14.86	14.01 – 15.70	16.68	15.75 – 17.61	0.90	0.82 – 1.00
Self-reported poor health status	3.19	2.79 – 3.60	5.77	5.26 – 6.29	0.72	0.61 – 0.87
Reported morbidity
Arterial hypertension	22.79	21.87 – 23.71	25.69	24.67 – 26.71	0.86	0.78 – 0.94
Diabetes	6.30	5.74 – 6.86	6.27	5.73 – 6.80	1.03	0.89 – 1.20
Breast cancer prevention (50 to 69 years old)
Mammography	94.39	92.82 – 95.96	83.09	81.04 – 85.14	2.66	1.86 – 3.81
Mammography in the past two years	85.70	83.59 – 87.82	63.39	60.69 – 66.09	2.81	2.23 – 3.54
Pap test (25 to 59 years old)
Pap test at any point in life	91.58	90.65 – 92.52	83.97	82.72 – 85.21	1.69	1.42 – 2.00
Pap test in the past three years	87.88	86.70 – 89.06	76.84	75.38 – 78.29	1.72	1.47 – 2.02

Variable	0 to 8 schooling years				9 to 11 years				12 years and more
	Health plan				Health plan				Health plan
	Yes	No	OR*	95%CI	Yes	No	OR*	95%CI	Yes	No	OR*	95%CI
Smoking
Smoker	12.18	20.67	0.66	0.59 – 0.74	9.13	12.09	0.69	0.58 – 0.82	9.63	10.21	0.88	0.67 – 1.16
Former smoker	32.79	29.1	0.99	0.91 – 1.09	18.34	16.51	0.94	0.83 – 1.08	16.97	14.14	1.02	0.80 – 1.29
Smokes 20 or more cigarettes	4.12	6.91	0.7	0.57 – 0.86	2.51	2.82	0.78	0.57 – 1.06	2.73	2.61	0.85	0.53 – 1.38
Passive smoker in the household	9.2	11.48	0.82	0.73 – 0.93	11.08	14.23	0.82	0.69 – 0.98	9.08	12.99	0.72	0.55 – 0.95
Passive smoker at work	11.02	12.77	0.82	0.73 – 0.93	10.51	14.01	0.76	0.64 – 0.89	7.15	9.84	0.75	0.56 – 1.00
Consumption
FVG regularly	37.81	27.53	1.36	1.26 – 1.47	34.52	26.93	1.3	1.16 – 1.46	46.18	33.61	1.52	1.30 – 1.79
FVG recommended	22.78	17.21	1.24	1.13 – 1.35	22.73	18.69	1.19	1.05 – 1.36	30.64	22.89	1.36	1.14 – 1.62
Meat with excessive fat	29.14	36.09	0.92	0.85 – 1	32.71	34.09	1	0.9 – 1.12	27.40	32.02	0.87	0.73 – 1.03
Whole milk	51.33	56.59	0.75	0.7 – 0.81	58.15	63.83	0.84	0.76 – 0.94	44.41	66.10	0.44	0.38 – 0.52
Soft drink on five days or more	22.55	26.57	0.91	0.83 – 0.99	28.35	32.12	0.92	0.81 – 1.03	25.64	30.05	0.86	0.72 – 1.03
Beans on five days or more	70.38	73.4	0.92	0.85 – 0.98	68.47	69.33	1	0.9 – 1.11	55.83	64.49	0.75	0.64 – 0.87
Physical activity
In free time	25.02	19.67	1.41	1.3 – 1.52	38.54	32.49	1.38	1.24 – 1.54	44.37	36.02	1.48	1.26 – 1.74
Commuting	9.61	18.34	0.66	0.59 – 0.73	14.26	18.48	0.77	0.67 – 0.9	12.35	20.28	0.59	0.47 – 0.75
In the household	42.15	46.78	0.63	0.59 – 0.68	34.32	44.16	0.62	0.55 – 0.68	19.06	34.01	0.44	0.37 – 0.51
At work	34.8	45.63	0.79	0.73 – 0.85	42.72	45.9	0.92	0.83 – 1.03	32.95	41.38	0.71	0.60 – 0.83
Leisure or transportation	19.96	26.07	0.88	0.82 – 0.96	30.14	31.65	0.98	0.88 – 1.1	29.69	33.04	0.89	0.75 – 1.05
Inactive	19.22	15.79	1.14	1.03 – 1.26	13.28	11.68	1.09	0.93 – 1.28	16.33	13.19	1.24	1.00 – 1.53
Alcohol consumption
Abusive	9.74	15	0.94	0.85 – 1.03	16.69	18.17	0.94	0.82 – 1.07	20.55	18.01	1.27	1.04 – 1.56
Driving after drinking	3.25	2.31	1.45	1.24 – 1.7	5.25	4.35	1.22	0.97 – 1.53	11.24	7.36	1.62	1.23 – 2.14
Health
Excess weight	57.48	53.94	1.05	0.97 – 1.13	48.3	44.53	1.04	0.94 – 1.16	46.33	39.25	1.20	1.03 – 1.40
Obesity	19.75	19.14	0.9	0.82 – 1	13.99	14.62	0.85	0.74 – 0.99	12.94	12.89	0.92	0.74 – 1.13
Self-reported poor health status	7.14	7.82	0.72	0.61 – 0.87	2.36	3.82	0.56	0.43 – 0.74	1.53	2.59	0.53	0.34 – 0.82
Reported morbidity
Arterial hypertension	41.07	34.32	0.86	0.78 – 0.94	18.2	17.13	0.79	0.69 – 0.91	15.80	13.38	0.90	0.72 – 1.12
Diabetes	13.81	9.17	1.03	0.89 – 1.2	4.44	3.4	0.93	0.72 – 1.2	3.42	2.07	1.15	0.74 – 1.78
Breast cancer prevention (50 to 69 years old)
Mammography	90.91	81.86	2.66	1.86 – 3.81	96.95	85.83	5.25	3.11 – 8.88	96.89	89.14	3.83	1.36 – 10.81
Mammography in the past two years	80.15	60.98	2.81	2.23 – 3.54	88.29	70.53	3.32	2.38 – 4.64	91.10	67.65	4.95	2.79 – 8.81
Pap test (25 to 59 years old)
Pap test at any point in life	90.28	84.65	1.69	1.42 – 2	91.21	82.3	1.97	1.55 – 2.5	92.44	86.75	1.55	1.08 – 2.23
Pap test in the past three years	82.33	76	1.72	1.47 – 2.02	87.57	76.75	1.95	1.58 – 2.42	90.49	81.03	1.97	1.44 – 2.68

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[1] Corresponding author: Deborah Carvalho Malta. Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde. SAF Sul, Trecho 2, Lote 5/6, Torre I, Edifício Premium, Sala 14, Térreo, CEP: 70070-600, Brasília, DF, Brasil. E-mail: deborah.malta@saude.gov.br