Use of health services and adherence to social distancing by adults with Noncommunicable Diseases during the COVID-19 pandemic, Brazil, 2020

Malta, Deborah Carvalho; Gomes, Crizian Saar; Silva, Alanna Gomes da; Cardoso, Laís Santos de Magalhães; Barros, Marilisa Berti de Azevedo; Lima, Margareth Guimarães; Souza Junior, Paulo Roberto Borges de; Szwarcwald, Célia Landmann

doi:10.1590/1413-81232021267.00602021

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FREE THEMES • Ciênc. Saúde Colet. 26 (07) • July 2021 • https://doi.org/10.1590/1413-81232021267.00602021 copy

Use of health services and adherence to social distancing by adults with Noncommunicable Diseases during the COVID-19 pandemic, Brazil, 2020

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The present study investigates the association between the self-reported diagnosis of noncommunicable disease (NCD) and the adherence to social distancing and the use of health services during the COVID-19 pandemic. This was a cross-sectional study with Brazilian adults who participated in the ConVid- Behavior Survey, conducted online between April 24 and May 24, 2020(n = 45.161). This studyconsidered the following NCDs: diabetes, hypertension, respiratory disease, heart disease, and cancer, and evaluated the use of health services and the adherence to social distancing, as well as estimated the prevalences and adjusted prevalence ratio (aPR); 33,9% (95% CI: 32,5-35,3) referred to one or more NCD. Individuals with NCDsshowed a greater adherence to intense social distancing (aPR: 1,07;95% CI: 1,03-1,11), sought out health services more often (aPR:1,24; 95% CI:1,11-1,38), and found greater difficultyin scheduling doctor’s appointments (aPR:1.52; 95% CI 1,35-1,71), receiving healthcare treatment (APR:1,50;95% CI:1,22-1,84) and medication (APR:2,17;95% CI:1,77-2,67), and performing examinations (APR:1,78;95% CI:1,50-2,10) and scheduled interventions (APR:1,65;95% CI:1,16-2,34). The presence of NCDs was associated with social distancing, seeking out health care, and difficulty in using health services.

Key words:
Quarantine; Infection by coronavirus; Noncommunicable diseases; Access to health services

Variables	% (95% CI)
Sex
Male	46. 4 (45.0 - 47. 9)
Female	53.6 (52. 1 - 55.0)
Age Group
18 to 39 years	45.7 (44.2 - 47.1)
40 to 59 years	34.0 (32.7 - 35.4)
60 years or older	20.3 (19.1 - 21.6)
Education
Incomplete High School	11.1 (10.1 - 12.3)
Complete High School	72.4 (71.3 - 73.5)
Complete College	16.5 (16.0 - 17.0)
Race/Color
White	45.2 (43.8 - 46.6)
Dark-skinnedBlack	8.3 (7.5 - 9.2)
Light-skinned Black	45.7 (44.2 - 47.2)
Other	0.8 (0.6 -0. 9)

Variables	Have one or more NCD	Hypertension	Diabetes	Respiratory Disease	Heart Disease	Cancer
Variables	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
Total	33.9 (32.5-35.3)	19.3 (18.2-20.4)	7.2 (6.5-8.0)	11.3 (10.4-12.2)	4.3 (3.7-5.0)	2.4 (2.1-2.9)
Sex
Male	33.3 (31.0-35.7)	19.7 (17.9-21.7)	7.7 (6.5-9.1)	10.2 (8.8-11.8)	4.8 (3.8-6.1)	2.0 (1.4-2.8)
Female	34.4 (32.8-35.9)	18.9 (17.6-20.2)	6.8 (5.9-7.8)	12.3 (11.3-13.3)	3.9 (3.2-4.8)	2.8 (2.4-3.3)
Age Group
18 to 39 years	19.6 (18.0-21.3)	4.7 (3.9-5.6)	1.7 (1.3-2.3)	13.4 (12.1-14.8)	1.6 (1.2-2.2)	0.7 (0.4-1.1)
40 to 59 years	38.3 (36.0-40.6)	25.4 (23.4-27.5)	8.8 (7.6-10.3)	9.6 (8.4-10.8)	3.9 (3.20-4.8)	2.2 (1.8-2.8)
60 years or older	58.6 (55.3-61.9)	41.8 (38.5-45.2)	16.9 (14.4-19.7)	9.5 (7.4-12.0)	11.2 (8.8-14.1)	6.7 (5.3-8.4)
Education
Incomplete High School	39.3 (34.4-44.5)	28.6 (24.3-33.4)	9.7 (7.4-12.6)	7.9 (5.5-11.4)	5.4 (3.8-7.6)	3.0 (2.1-4.3)
Complete High School	34.0 (32.3-35.7)	18.5 (17.2-20.0)	7.2 (6.3-8.3)	12.1 (11.0-13.3)	4.4 (3.7-5.4)	2.3 (1.8-2.9)
Complete College	29.8 (29.2-30.5)	16.2 (15.7-16.7)	5.4 (5.1-5.7)	10.0 (9.6-10.4)	3.1 (2.9-3.4)	2.7 (2.5-2.9)

Variables	Has no NCD % (95% CI)	Has one or more NCD % (95% CI)	GrossPR* (95% CI)	AdjustedPR^† (95% CI)
Sought an appointment with doctor, dentist or other healthcare professional	20.4 (19.0 - 21.8)	24.2 (22.2 - 26.2)	1.18 (1.06 - 1.31)	1.24 (1.11 - 1.39)
Difficulty to schedulean appointment	16.7 (15.4 - 18.1)	23.6 (21.7 - 25.6)	1.41 (1.25 - 1.59)	1.52 (1.35 - 1.71)
Difficulty to receivehealth care	8.2 (7.2 - 9.4)	11.2 (9.6 - 12.9)	1.36 (1.11 - 1.65)	1.50 (1.22 - 1.84)
Difficulty in obtainingmedication	5.8 (5.0 - 6.7)	11.3 (9.7 - 13.1)	1.94(1.57 - 2.39)	2.17 (1.77 - 2.67)
Difficulty to receiveprescribed examination	9.3 (8.2 - 10.4)	16.5 (14.7 - 18.5)	1.78 (1.51 - 2.10)	1.78 (1.50 - 2.10)
Difficulty in having scheduledinterventions	2.4 (1.9 - 3.0)	3.6 (2.8 - 4.6)	1.49 (1.08 - 2.05)	1.65 (1.16 - 2.34)
Difficultytobehospitalized	0.7 (0.3 - 1.5)	0.8 (0.4 -1.6)	1.20 (0.42 - 3.47)	1.70 (0.60 - 4.79)

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[1] Collaborations

All authors worked in the conception and planning of the study, data analysis, writing and critical revision of the article, and approval of the version to be published.