<i>Desigualdades na assistência à saúde e no acesso aos serviços de saúde em adultos brasileiros com autorrelato de hipertensão arterial:</i> Pesquisa Nacional de Saúde

Malta, Deborah Carvalho; Gomes, Crizian Saar; Stopa, Sheila Rizzato; Andrade, Fabiana Martins Dias de; Prates, Elton Junio Sady; Oliveira, Patrícia Pereira Vasconcelos de; Ferreira, Sheila Aparecida Massardi; Pereira, Cimar Azeredo

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ARTICLE • Cad. Saúde Pública 38 (Suppl 1) • 2022 • https://doi.org/10.1590/0102-311Xe00125421 copiar

Desigualdades na assistência à saúde e no acesso aos serviços de saúde em adultos brasileiros com autorrelato de hipertensão arterial: Pesquisa Nacional de Saúde

Autoria SCIMAGO INSTITUTIONS RANKINGS

Este estudo comparou indicadores de cuidados e acesso aos serviços de saúde por adultos que se autodeclararam hipertensos em 2013 e 2019, analisando esses indicadores de acordo com o sexo, grupo etário, nível de escolaridade, e rala/cor. Estudo analítico com dados da Pesquisa Nacional de Saúde (PNS), realizado em 2013 e 2019 no Brasil. Os indicadores de cuidados e acesso aos serviços de saúde por indivíduos com hipertensão arterial em ambos os inquéritos foram comparados. Para 2019, esses indicadores foram analisados de acordo com características sociodemográficas. Este estudo estimou as proporções, as razões de prevalência (RP), e os respectivos intervalos de 95% de confiança (IC95%). No total, 60.202 indivíduos foram avaliados em 2013 e 88.531 em 2019, destes 24,4% referiram hipertensão arterial em 2013 e 23,9% em 2019. As mulheres receberam mais cuidados médicos para hipertensão no último ano (RP = 1,07; IC95%: 1,04; 1,11) e a última consulta médica na unidade básica de saúde (RP = 1,11; IC95%: 1,05; 1,17) que homens. Sobre raça/cor, os negros tiveram mais hospitalização por hipertensão ou alguma complicação (RP = 1,2; IC95%: 1,05; 1,38) e grau de limitação intenso ou muito intenso na realização de atividades diárias (RP = 1,37; IC95%: 1,06; 1,76). Em 2019, foram evidenciadas desigualdades e piores indicadores foram observados em homens, negros, com baixa escolaridade e idade jovem. Investimentos no Sistema Único de Saúde brasileiro, bem como políticas públicas e ações são essenciais para reduzir as desigualdades, promover os cuidados de saúde.

Palavras-chave:
Hipertensão; Disparidades nos Níveis de Saúde; Doenças Crônicas; Fatores de Risco; Atenção Primária à Saúde

Indicators	Total		Gender
	Total		Male (A)		Female (B)		Adjusted PR (B/A)	95%CI
	%	95%CI	%	95%CI	%	95%CI
Prescribed medication	95.4	94.9; 95.8	938	92.9; 94.5	96.5	95.9; 97.0	1.02	1.01; 1.03
Use of medication in the previous two weeks	86.9	86.1; 87.7	831	81.7; 84.5	89.6	88.6; 90.5	1.06	1.04; 1.08
At least one medication from the “We Have a Popular Pharmacy Here” program	45.1	43.6; 46.5	437	41.7; 45.7	46.0	44.3; 47.7	1.03	0.98; 1.08
Received medical care for hypertension within the last year	72.2	71.1; 73.3	68.9	67.3; 70.5	74.5	73.1; 75.8	1.07	1.04; 1.11
Had the last physician appointment at an UBS	45.8	44.4; 47.2	41.8	39.7; 43.9	48.5	46.9; 50.2	1.11	1.05; 1.17
Had an appointment with the same physician as in the previous appointments	51.9	50.6; 53.3	52.3	50.3; 54.3	51.7	49.8; 53.5	0.99	0.94; 1.05
Appointments with a specialist	49.0	47.6; 50.4	49.5	47.4; 51.5	48.6	46.8; 50.5	1.01	0.96; 1.07
Referral for appoint with a specialist	79.1	76.8; 81.1	78.6	75.0; 81.8	79.3	76.5; 82.0	1.01	0.96; 1.06
Hospitalization for hypertension or some complication	15.0	14.2; 15.9	13.6	12.4; 15.0	15.9	14.8; 17.1	1.14	1.01; 1.28
Intense or very intense degree of limitation in performing daily activities	3.0	2.7; 3.4	3.1	2.5; 3.7	3.0	2.6; 3.5	0.93	0.73; 1.17

Indicator	Age Group (years)
	18-29 (A)		30-59 (B)		≥ 60 (C)		Adjusted PR B/A	95%CI	Adjusted PR (C/A)	95%CI
	%	95%CI	%	95%CI	%	95%CI
Prescribed medication	68.4	61.6; 74.5	93.3	92.4; 94.1	98.8	98.4; 99.0	1.35	1.23; 1.49	1.43	1.30; 1.57
Use of medication in the previous two weeks	39.3	31.9; 47.2	81.9	80.6; 83.2	94.3	93.6; 94.9	2.05	1.69; 2.49	2.34	1.93; 2.85
At least one medication from the program “We Have a Popular Pharmacy Here”	21.1	14.0; 30.6	45.7	43.3; 48.0	45.1	43.5; 46.7	2.16	1.46; 3.20	2.08	1.41; 3.08
Received medical care for hypertension within the last year	62.9	54.9; 70.3	71.1	69.5; 72.8	73.7	72.3; 75.0	1.11	0.98; 1.25	1.13	1.00; 1.27
Had the last physician appointment at UBS	47.1	38.6; 55.7	45.5	43.6; 47.4	46.0	44.3; 47.8	0.95	0.80; 1.14	0.92	0.76; 1.10
Had appointment with the same physician as in the previous appointments	37.6	29.4; 46.6	49.6	47.6; 51.5	54.9	53.2; 56.7	1.29	1.02; 1.62	1.42	1.13; 1.79
Appointments with a specialist	64.2	48.3; 77.8	75.4	71.7; 78.8	83.4	80.6; 85.9	1.17	0.93; 1.47	1.31	1.04; 1.64
Referral for appointment with a specialist	35.8	28.0; 44.5	46.4	44.3; 48.5	52.1	50.4; 53.9	1.27	1.02; 1.58	1.47	1.18; 1.83
Hospitalization for hypertension or some complication	13.0	8.3; 19.9	14.1	12.9; 15.5	16.0	14.8; 17.2	1.02	0.65; 1.58	1.07	0.69; 1.68
Intense or very intense degree of limitation in performing daily activities	2.9	1.2; 6.8	3.1	2.6; 3.8	2.9	2.5; 3.4	0.92	0.37; 2.26	0.70	0.29; 1.72

Indicators	Level of education
	No education or incomplete primary school (A)		Complete primary school and incomplete high school (B)		Complete high school and incomplete higher education (C)		Complete higher education (D)		Adjusted PR (B/A)	95%CI	Adjusted PR (C/A)	95%CI	Adjusted PR (D/A)	95%CI
	%	95%CI	%	95%CI	%	95%CI	%	95%CI
Prescribed medication	96.4	95.8; 96.8	93.3	91.5; 94.7	93.4	92.0; 94.5	96.8	95.7; 97.7	0.99	0.97; 1.01	0.99	0.98; 1.01	1.01	1.00; 1.02
Use of medication in the previous two weeks	89.2	88.2; 90.1	84.4	81.8; 86.8	82.2	80.0; 84.2	88.4	86.4; 90.2	1.00	0.97; 1.02	0.97	0.94; 1.00	1.01	0.98; 1.03
At least one medication from the “We Have a Popular Pharmacy Here” program	47.9	46.1; 49.7	50.4	46.7; 54.1	43.0	40.2; 45.9	30.9	27.8; 34.2	1.07	0.99; 1.16	0.93	0.86; 1.00	0.70	0.62; 0.79
Received medical care for hypertension within the last year	73.7	72.3; 75.1	73.0	69.7; 76.1	69.6	67.3; 71.9	69.2	66.1; 72.1	0.99	0.95; 1.04	0.94	0.91; 0.98	0.91	0.87; 0.96
Had the last physician’s appointment at UBS	57.2	55.5; 58.9	44.4	40.8; 48.1	35.1	32.3; 38.0	15.4	12.9; 18.4	0.86	0.80; 0.93	0.77	0.72; 0.84	0.52	0.44; 0.62
Had an appointment with the same physician as in the previous appointments	49.9	48.2; 51.7	51.0	47.4; 54.6	52.1	49.3; 54.8	61.9	58.4; 65.2	1.01	0.94; 1.09	0.99	0.93; 1.06	1.06	0.98; 1.14
Appointments with a specialist	42.7	40.9; 44.5	48.6	45.0; 52.2	53.4	50.7; 56.0	70.1	66.7; 73.2	1.00	0.92; 1.10	1.03	0.97; 1.10	1.09	1.00; 1.18
Referral for appointment with a specialist	78.1	75.2; 80.8	75.8	69.4; 81.3	79.9	75.2; 83.9	87.1	81.2; 91.3	1.11	1.02; 1.20	1.14	1.07; 1.23	1.27	1.18; 1.37
Hospitalization for hypertension or some complication	17.2	16.0; 18.5	13.9	11.7; 16.6	12.4	10.8; 14.3	11.0	9.0; 13.4	0.83	0.69; 1.00	0.77	0.64; 0.91	0.71	0.56; 0.89
Intense or very intense degree of limitation in performing daily activities	4.1	3.6; 4.7	3.0	2.1; 4.2	1.6	1.2; 2.1	1.0	0.5; 1.8	0.69	0.47; 1.03	0.38	0.26; 0.54	0.25	0.13; 0.48

Indicator	Ethnicity
	White (A)		Black (B)		Mixed-race (C)		Adjusted PR (B/A)	95%IC	Adjusted PR (C/A)	95%CI
	%	95%CI	%	95%CI	%	95%CI
Prescribed medication	96.2	95.5; 96.8	95.0	93.5; 96.2	94.5	93.7; 95.2	1.00	0.98; 1.01	1.00	0.98; 1.01
Use of medication in the previous two weeks	88.5	87.2; 89.6	86.7	84.6; 88.6	85.3	84.1; 86.5	0.99	0.97; 1.01	1.00	0.98; 1.03
At least one medication from the “We Have a Popular Pharmacy Here” program	44.8	42.9; 46.8	46.3	43.0; 49.7	44.8	42.8; 46.9	0.94	0.89; 1.00	0.97	0.89; 1.06
Received medical care for hypertension within the last year	71.5	69.9; 73.1	74.7	71.9; 77.3	72.1	70.5; 73.7	1.01	0.98; 1.04	1.05	1.01; 1.09
Had the last physician appointment at UBS	39.4	37.3; 41.6	51.9	48.6; 55.2	50.7	48.9; 52.5	1.01	0.96; 1.07	1.06	0.98; 1.14
Had appointment with the same physician as in the previous appointments	56.7	54.6; 58.7	48.8	45.4; 52.2	48.2	46.3; 50.2	0.92	0.87; 0.97	0.93	0.85; 1.00
Appointments with a specialist	54.6	52.5; 56.6	47.9	44.6; 51.3	43.4	41.5; 45.3	0.96	0.91; 1.01	0.94	0.87; 1.02
Referral for appointment with a specialist	82.9	79.7; 85.7	75.4	68.9; 80.9	76.7	73.3; 79.7	0.92	0.88; 0.97	1.02	0.94; 1.09
Hospitalization for hypertension or some complication	13.2	11.9; 14.6	15.7	13.5; 18.2	16.8	15.4; 18.3	1.20	1.05; 1.38	1.14	0.95; 1.36
Intense or very intense degree of limitation in performing daily activities	2.2	1.8; 2.7	3.5	2.7; 4.6	3.6	3.1; 4.3	1.37	1.06; 1.76	1.38	0.99; 1.94

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
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[1] Correspondence
D. C. Malta Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, 5º andar, Belo Horizonte, MG 30130-100, Brasil. dcmalta@uol.com.br