Factors associated with not consulting a physician in the 12 months prior to interview with adults and elderly in the city of Rio Grande, Rio Grande do Sul, Brazil, 2016: a cross-sectional study

Almeida, Letícia Maria da Silva; Ferreira, Luiza Santos; Teixeira, Tarso Pereira; Dumith, Samuel Carvalho

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 29 (1) • 2020 • https://doi.org/10.5123/S1679-49742020000100004 copy

Factors associated with not consulting a physician in the 12 months prior to interview with adults and elderly in the city of Rio Grande, Rio Grande do Sul, Brazil, 2016: a cross-sectional study^* * Study funded by the Rio Grande do Sul State Research Support Foundation (FAPERGS): Process No. 16/2551-0000359-9. Samuel Carvalho Dumith is undertaking a research productivity fellowship with the National Scientific and Technological Development Council (CNPq)/Ministry of Science, Technology, Innovation and Communications (MCTIC). Letícia Maria da Silva Almeida is undertaking a scientific initiation fellowship with CNPq/MCTIC.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to investigate prevalence and factors associated with not consulting a physician

in the last 12 months in Rio Grande, RS, Brazil, 2016.

Methods:

this was a population-based cross-sectional study, using Poisson regression for multivariate analysis.

Results:

a total of 1,297 individuals took part in the study; average age was 46 years old (SD=17, ranging from 18 to 96); and median per capita family income was BRL 1,000 in the last month (IQR: 600 - 1,760); prevalence of non-consultation in the last 12 months was 20.0% (95%CI 17.5;22.6); associated factors, after adjusting for potential confounders, were male sex, being single, having low schooling, excessive alcohol consumption, smoking, having fewer comorbidities, and having no health plan.

Conclusion:

one in five individuals did not consult a doctor in the last 12 months; use of this service was lower among the poorest and those with a poorer lifestyle.

Keywords:
Equity; Medical Care; Health Services Accessibility; Health Services Research; Cross-Sectional Studies

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: Letícia Maria da Silva Almeida - Rua Visconde de Paranaguá, No. 102, Centro, Rio Grande, RS, Brazil. Postcode: 96203-900 E-mail: leticiamsalmeida@hotmail.com

Variable	n	%
Sex
Male	563	43.4
Female	734	56.6
Age range (in years)
18-39	508	39.1
40-59	477	36.8
≥60	312	24.1
Race/skin color (n=1,285)
White	1.074	83.6
Brown	103	8.0
Black	108	8.4
Marital status
Single	600	46.3
Married/separated/divorced/widowed	697	53.7
Living alone (n=1,296)
No	1.172	90.4
Yes	124	9.6
Schooling (in years) (n=1,295)
0-8	541	41.8
9-11	399	30.8
≥12	355	27.4
Family income (in terciles) (n=1,169)
Lowest	426	36.4
Intermediate	366	31.1
Highest	377	32.3
Tobacco smoking
No	1.064	82.0
Yes	233	18.0
Abusive alcohol intake (n=1,294)
No	1.142	88.2
Yes	152	11.8

Variable	N	%
Morbidities (number of health problems) (1,274)
0	561	44.1
1	326	25.6
2	212	16.6
3 or more	175	13.7
Self-perception of health
Excellent or very good	278	21.4
Good	582	44.9
Regular or poor	437	33.7
Has health insurance
No	615	47.4
Yes	682	52.6
Visited by an ACS^a
No	987	76.1
Yes	310	23.9
Had last medical consultation on the SUS^b (n=1,279)
No	749	58.6
Yes	530	41.4
Household within UBSF^c catchment area, as reported by interviewee (n=1,296)
No	842	65.0
Yes	454	35.0
Household neighborhood within UBSF^c catchment area, as mapped by City Health Department
No	808	62.3
Yes	489	37.7
TOTAL	1,297	100.0

Level	Variable	% non-consultation	Crude analysis			Adjusted analysis
Level	Variable	% non-consultation	PR ^a (95%CI^b)	p value ^c	PR ^a (95%CI^b)	p value ^c
1	Sex			<0.01		0.01
	Male	24.3	1.45 (1.14;1.85)		1.41 (1.09;1.81)
	Female	16.8	1.00		1.00
1	Age range (in years)			0.23		0.15
	18-39	18.5	1.00		1.00
	40-59	22.6	1.22 (0.92;1.63)		1.31 (0.96;1.80)
	≥60	18.6	1.01 (0.72;1.41)		1.09 (0.74;1.62)
1	Race/skin color			0.17		0.51
	White	19.3	1.00		1.00
	Brown	27.2	1.41 (0.97;2.05)		1.23 (0.85;1.80)
	Black	19.4	1.01 (0.67;1.51)		1.00 (0.67;1.51)
1	Marital status			0.09		0.02
	Single	22.2	1.22 (0.97;1.53)		1.36 (1.06;1.76)
	Married/separated/divorced/widowed	18.2	1.00		1.00
1	Lives alone			0.18		0.78
	No	19.5	1.00		1.00
	Yes	25.0	1.28 (0.89;1.84)		1.06 (0.71;1.57)
1	Schooling (in years of study)			0.01		0.02
	0-8	23.5	1.57 (1.19;2.08)		1.56 (1.14;2.13)
	9-11	19.8	1.33 (1.00;1.76)		1.34 (1.01;1.78)
	≥12	14.9	1.00		1.00
1	Family income (in terciles)			0.09		0.34
	Lowest	24.7	1.39 (1.00;1.93)		1.18 (0.80;1.76)
	Intermediate	18.9	1.06 (0.74;1.51)		0.94 (0.64;1.39)
	Highest	17.8	1.00		1.00
2	Tobacco smoking			<0.01		0.01
	No	18.0	1.00		1.00
	Yes	29.6	1.65 (1.33;2.05)		1.38 (1.09;1.73)
2	Excessive alcohol intake			<0.01		0.01
	No	18.6	1.00		1.00
	Yes	30.9	1.67 (1.24;2.24)		1.50 (1.10;2.04)

Level	Variable	% non-consultation	Crude analysis			Adjusted analysis
Level	Variable	% non-consultation	PR^a (95%CI^b)	p value^c	PR^a (95%CI^b)	p value^c
3	Morbidities (number of health problems)			<0.01		<0.01
	0	26.0	4.14 (2.09;8.21)		4.91 (2.52;9.54)
	1	20.6	3.27 (1.67;6.39)		3.79 (1.95;7.38)
	2	14.6	2.33 (1.21;4.46)		2.46 (1.27;4.76)
	3	6.3	1.00		1.00
3	Self-perception of health			<0.01		0.25
	Excellent or very good	20.5	1.45 (1.07;1.95)		1.24 (0.89;1.72)
	Good	24.2	1.71 (1.32;2.21)		1.28 (0.95;1.72)
	Regular or poor	14.2	1.00		1.00
4	Has health insurance			<0.01		0.01
	No	27.2	1.99 (1.58;2.51)		1.55 (1.10;2.17)
	Yes	13.3	1.00		1.00
4	Visited by an ACS^d			0.89		0.23
	No	20.0	0.98 (0.77;1.26)		1.18 (0.90;1.56)
	Yes	20.3	1.00		1.00
4	Had last medical consultation on the SUS^e			<0.01		0.06
	No	14.6	1.00		1.00
	Yes	25.3	1.74 (1.38;2.19)		1.34 (0.99;1.81)
4	Household within UBSF^c catchment area, as reported by interviewee			0.77		0.30
	No	19.8	0.97 (0.78;1.21)		1.16 (0.88;1.52)
	Yes	20.5	1.00		1.00
4	Household neighborhood within UBSF^c catchment area, as mapped by City Health Department			0.10		0.40
	No	18.4	0.81 (0.63;1.08)		0.96 (0.68;1.37)
	Yes	22.7	1.00		1.00