Reduction of inequalities in medical visits in Brazil: analysis of the Northeastern and Southeastern regions between 2003 and 2008

Silva, Paulo Sérgio Cardoso da; Boing, Antonio Fernando; Peres, Karen Glazer

doi:10.1590/1980-5497201500010019

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Original Articles • Rev. bras. epidemiol. 18 (1) • Mar 2015 • https://doi.org/10.1590/1980-5497201500010019 copy

Reduction of inequalities in medical visits in Brazil: analysis of the Northeastern and Southeastern regions between 2003 and 2008

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To analyze the socioeconomic inequalities in medical visits (MV) in the past year in Brazil.

METHODS:

Data from adults aged ≥ 20 years old who participated in the Brazilian National Household Surveys and living in the Northeastern (2003; n = 75,652 and 2008, n = 79,779) and Southeastern (2003; n = 76,029 and 2008; n = 79,356) regions were analyzed according to MV. We compared MVs according to demographic and health variables in the first (D1) and last (D10) per capita family income deciles. All analyses considered the complex cluster design.

RESULTS:

The proportion of people who had MV during this period increased in the Northeastern (from 61.2 to 66.9%) and the Southeastern (from 67.9 to 73.5%) regions. The absolute difference (AD) in the use of MV, according to D1 and D10 in this period, was equal to 6.4 percentage points (pp) in the Northeastern and 4.2 pp in the Southeastern regions. Significant reduction in inequalities was observed among men without chronic diseases, in those who had a positive perception of their health, and among those without health insurance which included MV. The Southeastern region has also showed significant reduction among those with chronic disease (8 pp) and with negative health self-perception (6 pp).

CONCLUSION:

The increasing number of MVs was found in Brazil. However, persistent inequalities were observed between the poorest and the richest, higher in the Northeastern than in the Southeastern region. More effective and equitable policies to reduce health inequalities should be adopted in Brazil.

Health services; Health inequalities; Socioeconomic factors; Epidemiology; Brazil; Medical consultation

Variables	2003		2008
	Total	Visited a doctor in the past 12 months	Total	Visited a doctor in the past 12 months
	n (%)	% (95%CI)	n (%)	% (95%CI)
Total Northeastern sample	75,652	61.2 (60.2 – 62.2)	79,779	66.9 (66.0 – 67.7)
Gender*
Male	35,718 (47.2)	47.6 (46.5 – 48.8)	37,502 (47.0)	54.2 (53.2 – 55.2)
Female	39,934 (52.8)	73.5 (72.6 – 74.5)	42,277 (53.0)	78.3 (77.5 – 79.2)
Age (years)*
20 – 29	23,349 (30.9)	54.7 (53.5 – 55.9)	22,918 (28.7)	61.0 (59.9 – 62.1)
30 – 39	18,175 (24.0)	58.8 (57.5 – 60.1)	18,356 (23.0)	64.7 (63.6 – 65.8)
40 – 49	13,612 (18.0)	62.3 (61.0 – 63.5)	15,333 (19.2)	66.9 (65.8 – 68.0)
50 – 59	9,170 (12.1)	66.3 (64.9 – 67.7)	10,645 (13.3)	71.2 (70.0 – 72.4)
≥ 60	11,324 (15.0)	72.2 (70.8 – 73.5)	12,527 (15.7)	76.7 (75.7 – 77.7)
Income*
1^stdecile	15,051 (20.4)	54.7 (53.3 – 56.0)	14,188 (18.2)	60.8 (59.5 – 62.1)
10^thdecile	3,791 (5.1)	82.0 (80.3 – 83.7)	4,534 (5.8)	81.7 (80.2 – 83.2)
Self-reported morbidity*
No diseases	47,053 (62.2)	50.9 (49.7 – 52.0)	49,090 (61.5)	57.5 (56.5 – 58.5)
1 disease	16,032 (21.2)	72.7 (71.7 – 73.8)	17,579 (22.0)	76.9 (75.9 – 77.9)
≥ 2 diseases	12,556 (16.6)	84.9 (83.6 – 86.2)	13,110 (16.4)	88.3 (87.5 – 89.0)
Health self-perception*
Positive	50,052 (66.2)	53.5 (52.2 – 54.7)	52,580 (65.9)	60.3 (59.2 – 61.3)
Negative	25,595 (33.8)	75.4 (74.5 – 76.2)	27,199 (34.1)	78.9 (78.0 – 79.7)
Health insurance plan giving access to medical visits*
No	68,045 (89.9)	59.2 (58.2 – 60.2)	70,943 (88.9)	65.2 (64.3 – 66.0)
Yes	7,604 (10.1)	83.4 (82.3 – 84.5)	8,836 (11.1)	84.2 (83.2 – 85.1)

Variables	2003		2008
	Total	Visited a doctor in the past 12 months	Total	Visited a doctor in the past 12 months
	n (%)	% (95%CI)	n (%)	% (95%CI)
Total Southeastern sample	76,029	67.9 (67.2 – 68.5)	79,356	73.5 (73.0 – 74.1)
Gender*
Male	35,787 (47.1)	56.2 (55.4 – 57.0)	37,264 (47.0)	62.3 (61.6 – 63.1)
Female	40,242 (52.9)	78.2 (77.6 – 78.9)	42,092 (53.0)	83.4 (82.9 – 84.0)
Age (years)*
20 – 29	20,112 (26.5)	58.7 (57.8 – 59.7)	19,200 (24.2)	65.1 (64.1 – 66.0)
30 – 39	17,456 (23.0)	64.7 (63.7 – 65.7)	17,021 (21.5)	70.7 (69.8 – 71.6)
40 – 49	15,693 (20.7)	69.0 (68.1 – 69.9)	16,353 (20.6)	74.0 (73.2 – 74.8)
50 – 59	10,696 (14.1)	73.5 (72.5 – 74.5)	12,581 (15.9)	77.5 (76.6 – 78.4)
≥ 60	12,047 (15.9)	81.2 (80.4 – 82.0)	14,201 (17.9)	84.3 (83.5 – 85.0)
Income*
1^stdecile	4,463 (6.07)	61.5 (59.8 – 63.3)	3,711 (4.91)	68.6 (66.7 – 70.4)
10^thdecile	9,435 (12.84)	78.3 (77.1 – 79.4)	9,421 (12.47)	81.2 (80.2 – 82.1)
Self-reported morbidity*
No diseases	43,497 (57.2)	56.8 (55.9 – 57.6)	44,388 (55.9)	63.6 (62.8 – 64.3)
1 disease	17,462 (23.0)	76.6 (75.9 – 77.4)	18,480 (23.3)	81.7 (81.0 – 82.4)
≥ 2 diseases	15,035 (19.8)	90.0 (89.5 – 90.6)	16,488 (20.8)	91.3 (90.7 – 91.8)
Health self-perception*
Positive	57,047 (75.0)	62.2 (61.5 – 63.0)	58,689 (74.0)	68.8 (68.1 – 69.4)
Negative	18,976 (25.0)	85.0 (84.4 – 85.7)	20,667 (26.0)	87.3 (86.7 – 87.9)
Health insurance plan giving access to medical visits*
No	60,536 (79.6)	64.9 (64.2 – 65.6)	61,385 (77.4)	71.2 (70.6 – 71.9)
Yes	15,490 (20.4)	78.9 (78.1 – 79.8)	17,971 (22.7)	81.0 (80.3 – 81.8)

Variable	2003				2008
	Prevalence			Ratio	Prevalence			Ratio
	All	D1	D10	D10/D1*	All	D1	D10	D10/D1*
Total sample	61.2	54.7	82.0	1.50	66.9	60.8	81.7	1.34
Gender
Male	47.6	38.9	72.9	1.87	54.2	45.3	73.0	1.61
Female	73.5	68.0	90.3	1.33	78.3	74.1	89.7	1.21
Age (years)
20 – 29	54.7	53.6	73.3	1.37	61.0	59.9	77.6	1.30
30 – 39	58.8	53.4	80.3	1.50	64.7	60.9	78.0	1.28
40 – 49	62.3	55.3	83.7	1.51	66.9	59.8	82.1	1.37
50 – 59	66.3	58.2	88.0	1.51	71.2	63.6	81.8	1.29
≥ 60	72.2	63.2	86.5	1.37	76.7	65.7	89.2	1.36
Self-reported morbidity
No diseases	50.9	46.0	76.9	1.67	57.5	53.1	75.1	1.41
1 disease	72.7	70.7	84.9	1.20	76.9	72.8	88.3	1.21
≥ 2 diseases	84.9	80.2	92.2	1.15	88.3	84.9	93.1	1.10
Health self-perception
Positive	53.5	46.1	80.5	1.75	60.3	53.9	79.6	1.48
Negative	75.4	71.2	88.2	1.24	78.9	74.4	90.6	1.22
Health insurance plan giving access to medical visits*
No	59.2	54.6	75.9	1.39	65.2	60.7	76.0	1.25
Yes	83.4	75.7	88.3	1.17	84.2	77.7	87.8	1.13

Variable	2003				2008
	Prevalence			Ratio	Prevalence			Ratio
	All	D1	D10	D10/D1*	All	D1	D10	D10/D1*
Total Sample	67.9	61.5	78.3	1.27	73.5	68.6	81.2	1.18
Gender
Male	56.2	49.4	68.5	1.39	62.3	56.7	71.0	1.25
Female	78.2	70.1	87.0	1.24	83.4	76.4	90.5	1.19
Age (years)
20 – 29	58.7	58.7	70.9	1.21	65.1	65.6	72.5	1.10
30 – 39	64.7	60.5	75.4	1.25	70.7	66.8	79.4	1.19
40 – 49	69.0	61.3	80.0	1.31	74.0	70.8	81.2	1.15
50 – 59	73.5	69.0	78.9	1.14	77.5	71.6	82.3	1.15
≥ 60	81.2	79.3	86.4	1.09	84.3	79.6	89.0	1.12
Self-reported morbidity
No diseases	56.8	52.3	70.2	1.34	63.6	60.0	73.6	1.23
1 disease	76.6	69.9	85.0	1.21	81.7	78.0	87.8	1.13
≥ 2 diseases	90.0	86.1	93.6	1.09	91.3	84.3	94.1	1.12
Health self-perception
Positive	62.2	54.7	75.9	1.39	68.8	62.2	79.2	1.27
Negative	85.0	77.1	93.5	1.21	87.3	80.8	92.8	1.15
Health insurance plan giving access to medical visits*
No	64.9	61.1	74.7	1.22	71.2	67.9	78.0	1.15
Yes	78.9	81.1	81.7	1.01	81.0	87.4	84.1	0.96

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[1] Corresponding author: Karen Glazer Peres. Universidade Federal de Santa Catarina. Campus Universitário, Trindade, CEP: 88010-970, Florianópolis, SC, Brasil. E-mail: karen.peres@ufsc.br