Factors associated with poor access to health services in Brazil

This is a cross-sectional study based on data from the 2013 National Health Survey, obtained from a complex sample. The poor access outcome was defined as not having received care the last time the participant sought a health service and not seeking care again for lack of accessibility. We analyzed the prevalence of poor access and its association with socioeconomic and health factors by calculating prevalence ratios (PR) with 95% confidence intervals. We also used Poisson’s multivariate regression model with the Wald test for robust estimation.

Results:

Out of the 60,202 valid responses, 12,435 individuals met the criteria for poor access. Poor access had a prevalence of 18.1% (95%CI 16.8 - 19.4) and was associated with the following factors: being black/multiracial (PR = 1.2; 95%CI 1.0 - 1.4); living in the North (PR = 1.5; 1.3 - 1.9) and Northeast (PR = 1.4; 1.2 - 1.6) regions compared to the Southeast region; living in a rural area (PR = 1.2; 1.1 - 1.4); being a smoker (PR = 1.2; 1.0 - 1.4); having poor/very poor self-rated health (PR = 1.3; 1.1 - 1.6); not having private health insurance (PR = 2.3; 1.7 - 2.9).

Conclusion:

Access to health services is still precarious for a considerable part of the Brazilian population, especially the most vulnerable groups.

Keywords:
Health services accessibility; Health status disparities; Unified Health System; Health surveys

Variables	Prevalence (%) (N = 12,435)	95%CI
Poor access	18.1	16.8 - 19.4
Region
Southeast	12.9	11.0 - 14.9
South	11.2	9.0 - 13.8
Midwest	24.5	21.4 - 28.0
Northeast	27.0	24.5 - 29.7
North	31.1	26.9 - 35.6
Ethnicity
Other	12.9	11.3 - 14.6
Black and multiracial	23.3	21.6 - 25.2
Age (years)
18-24	19.8	16.4 - 23.7
25-39	18.5	16.5 - 20.8
40-59	19.3	17.5 - 21.3
60 or older	15.2	13.2 - 17.4
Schooling
No schooling	30.4	26.6 - 34.6
Elementary school	19.4	17.6 - 21.2
High school	17.2	15.0 - 19.6
Higher education or more	9.2	7.6 - 11.2
Smoking
Never smoked	16.8	15.3 - 18.3
Smoker	24.7	21.4 - 28.3
Ex-smoker	17.7	15.5 - 20.2
Alcohol consumption
Does not drink	18.1	16.7 - 19.5
Drinks moderately	17.1	14.2 - 20.5
Drinks heavily	20.3	15.8 - 25.8
Multimorbidity
No multimorbidity	20.1	18.5 - 21.8
2 morbidities	19.2	16.6 - 22.2
3 morbidities	11.1	9.0 - 13.6
4 or more morbidities	12.5	9.9 - 15.6
Self-rated health
Good/very good	14.5	12.9 - 16.3
Regular	19.9	18.0 - 21.9
Poor/very poor	25.0	21.7 - 28.7
Private medical or dental insurance
Yes	7.1	5.7 - 8.9
No	23.6	22.1 - 25.3

Variables	Crude PR	95%CI	p-value	Adjusted PR	95%CI	p-value
Region			< 0.01			< 0.01
Southeast	1			1
South	0.8	0.6 - 1.1		1.6	1.3 - 1.9
Midwest	1.9	1.5 - 2.3		0.8	0.6 - 1.1
Northeast	2.1	1.7 - 2.5		1.5	1.3 - 1.9
North	2.4	1.9 - 2.9		1.4	1.2 - 1.6
Ethnicity			< 0.01			0.01
Other	1			1
Black and multiracial	1.8	1.5 - 2.0		1.2	1.0 - 1.4
Age (years)			0.03			0.37
60+	1			1
18-24	1.3	1.0 - 1.6		0.9	0.7 - 1.1
25-39	1.2	1.0 - 1.4		0.9	0.7 - 1.1
40-59	1.2	1.0 - 1.5		0.8	0.6 - 1.0
Schooling			< 0.01			< 0.01
No schooling	1			1
Elementary school	0.6	0.5 - 0.7		0.7	0.6 - 0.8
High school	0.5	0.4 - 0.6		0.7	0.6 - 0.9
Higher education or more	0.3	0.2 - 0.3		0.5	0.4 - 0.7
Smoking			< 0.01			0.01
Never smoked	1			1
Smoker	1.4	1.2 - 1.7		1.2	1.0 - 1.4
Ex-smoker	1.0	0.9 - 1.2		0.9	0.8 - 1.1
Multimorbidity			< 0.01			< 0.01
No multimorbidity	1			1
2 morbidities	0.9	0.8 - 1.1		0.9	0.8 - 1.1
3 morbidities	0.5	0.4 - 0.6		0.5	0.4 - 0.7
4 or more morbidities	0.6	0.4 - 0.7		0.6	0.5 - 0.8
Self-rated health			< 0.01			< 0.01
Good/very good	1			1
Regular	1.3	1.1 - 1.5		1.1	1.0 - 1.3
Poor/very poor	1.7	1.4 - 2.0		1.3	1.1 - 1.6
Private medical/dental insurance			< 0.01			< 0.01
Yes	1			1
No	3.3	2.6 - 4.1		2.3	1.7 - 2.9
Alcohol consumption			0.53
Does not drink	1
Drinks moderately	0.9	0.7 - 1.1
Drinks heavily	1.1	0.8 - 1.4

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[1] Corresponding author: Talita Araujo de Souza. Rua General Gustavo Cordeiro de Faria, 601, Ribeira Natal, CEP: 59012-125, Natal, RN, Brasil. E-mail: talitaaraujo23@hotmail.com