Association between positive assessment of Primary Health Care, sociodemographic characteristics and comorbidities in Brazil

Carvalho, Fernanda Cunha de; Bernal, Regina Tomie Ivata; Perillo, Rosangela Durso; Malta, Deborah Carvalho

doi:10.1590/1980-549720220023

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Epidemiologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. bras. epidemiol. 25 • 2022 • https://doi.org/10.1590/1980-549720220023 copy

Association between positive assessment of Primary Health Care, sociodemographic characteristics and comorbidities in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe positive evaluations of Primary Health Care (PHC) in Brazil from the perspective of users and their association with sociodemographic characteristics and comorbidities.

Methods:

Analysis of the 2019 National Health Survey, in which 9,562 adults responded to the Primary Care Assessment Tool (PCATool). The association between positive PHC assessment (overall score ≥6.6) and individual characteristics was tested using Prevalence Ratios (PR) calculated by Poisson Regression.

Results:

Less than 40% of Brazilians rated PHC with a high score. Regarding the association of sociodemographic variables with high PHC assessment, adjusted for sex and age, the best PHC assessments were made by women [PR_aj 1.10 (95%CI 1.00–1.21)]; elderly (60 years and over) [PR_aj 1.27 (95%CI 1.09–1.48); people with a per capita income of 1 to 3 minimum wages (MW) PRaj 1.14 (95%CI 1.03–1.27) and ≥5 MW PRaj 1.75 (95%CI 1.39–2.21) when comparing with income up to 1 MW; residents of the South, Southeast and Midwest regions, compared to the North Region. Considering comorbidities, individuals with hypertension PRaj1,29 (95%CI 1.17–1.43); diabetes PRaj 1.21 (95%CI 1.08–1.36); heart disease PRaj 1.23 (95%CI 1.07–1.41); musculoskeletal disorders PRaj 1.36 (95%CI 1.10–1.69); lung disease PRaj 1.48 (95%CI 1.13–1.95) and obesity PRaj 1.15 (95%CI 1.03–1.28) rated PHC better when compared to normal weight people.

Conclusion:

Users who evaluate PHC well are usually women, elderly, with high prevalence of chronic non-communicable diseases. A positive evaluation of PHC, in general, results from greater use of health services.

Keywords:
Primary health care; Evaluation; health services; Health surveys; Noncommunicable diseases

	Mean overall score		Score ≥6.6
	Overall score	95%CI	%	95%CI
Brazil	5.9	5.8–5.9	38.1	36.3–39.9
Urban area	5.8	5.8–5.9	37.6	35.5–39.7
Rural area	6.0	5.9–6.1	40.4	37.0–43.8
North	5.5	5.3–5.7	30.1	26.3–34.2
Rondônia	5.6	5.2–5.9	22.6	14.8–32.9
Acre	5.3	4.9–5.7	27.5	19.9–36.8
Amazonas	5.8	5.4–6.2	39.1	30.7–48.1
Roraima	5.2	4.5–5.8	27.9	20.4–36.8
Pará	5.2	4.9–5.5	24.9	19.0–31.9
Amapá	5.4	5.0–5.7	24.9	15.9–36.8
Tocantins	5.9	5.5–6.2	36.8	27.7–46.9
Northeast	5.8	5.6–5.9	35.2	32.5–37.9
Maranhão	5.2	5.0–5.5	27.9	22.6–34.0
Piauí	6.0	5.7–6.3	40.6	33.8–47.7
Ceará	5.7	5.5–5.9	34.1	29.2–39.3
Rio Grande do Norte	6.0	5.7–6.2	38.3	31.0–46.2
Paraíba	6.0	5.7–6.3	45.4	38.1–52.9
Pernambuco	5.7	5.5–6.0	37.9	31.9–44.3
Alagoas	6.0	5.7–6.2	40.5	34.9–46.3
Sergipe	5.6	5.2–5.9	27.9	21.0–36.0
Bahia	5.7	5.5–6.0	31.5	24.8–39.1
Southeast	5.8	5.7–6.0	38.3	34.9–41.8
Minas Gerais	6.2	5.9–6.4	41.3	35.3–47.6
Espírito Santo	5.6	5.4–5.9	31.6	26.0–37.7
Rio de Janeiro	5.6	5.3–5.9	38.3	31.6–45.6
São Paulo	5.7	5.5–6.0	37.3	32.3–42.5
South	6.3	6.2–6.4	45.3	41.6–49.2
Paraná	6.1	5.8–6.3	39.8	34.5–45.4
Santa Catarina	6.4	6.2–6.6	45.3	39.0–51.8
Rio Grande do Sul	6.5	6.2–6.8	50.9	43.7–58.1
Midwest	5.8	5.6–6.0	37.9	33.0–43.1
Mato Grosso do Sul	5.9	5.6–6.2	37.1	30.0–44.8
Mato Grosso	6.6	6.2–6.9	53.3	43.5–62.8
Goiás	5.3	4.9–5.7	27.4	18.9–37.9
Federal District	5.7	5.2–6.1	38.1	29.4–47.8

Variables	Score ≥6.6		Prevalence ratio (95%CI)				p-value
Variables	%*	95%CI	crude		adjusted^†
Total	38.07	(36.23–39.94)
Sex
Male	36.02	(33.15–39.00)	1		1
Female	38.95	(36.79–41.17)	1.08	(0.98–1.19)	1.10	(1.00–1.21)	0.0460
Age
18–29	33.20	(28.86–37.84)	1		1
30–39	34.63	(30.50–39.00)	1.04	(0.87–1.25)	1.04	(0.87–1.25)	0.6700
40–49	38.65	(35.73–41.65)	1.16	(1.00–1.36)	1.17	(1.00–1.36)	0.0520
60+	41.67	(38.73–44.66)	1.26	(1.08–1.46)	1.27	(1.09–1.48)	0.0020
Educational level
0–8	40.22	(37.89–42.60)	1		1
9–11	34.94	(31.94–38.06)	0.87	(0.78–0.96)	0.92	(0.83–1.02)	0.1200
12+	34.53	(29.08–40.41)	0.86	(0.72–1.02)	0.91	(0.76–1.08)	0.2810
Ethnicity/skin color
White	36.87	(34.00–39.83)	1		1
Black	39.40	(34.16–44.90)	1.07	(0.91–1.25)	1.09	(0.93–1.27)	0.2930
Brown	38.55	(36.02–41.15)	1.05	(0.94–1.16)	1.07	(0.96–1.18)	0.2040
Region
North	30.05	(26.16–34.26)	1		1
North East	35.17	(32.32–38.12)	1.17	(1.00–1.37)	1.15	(0.98–1.35)	0.0860
Southeast	38.29	(34.86–41.83)	1.27	(1.08–1.50)	1.23	(1.05–1.45)	0.0130
South	45.35	(41.47–49.28)	1.51	(1.29–1.77)	1.46	(1.24–1.72)	0.0000
Midwest	37.94	(32.85–43.32)	1.26	(1.04–1.53)	1.24	(1.02–1.51)	0.0300
Income^‡
Up to 1 MW	36.01	(33.92–38.16)	1		1
1-3 MW	42.20	(38.58–45.90)	1.17	(1.06–1.30)	1.14	(1.03–1.27)	0.0150
3-5 MW	32.08	(23.38–42.24)	0.89	(0.66–1.20)	0.88	(0.65–1.19)	0.3960
5 or more MW	66.65	(49.43–80.33)	1.85	(1.45–2.37)	1.75	(1.39–2.21)	0.0000

Variables	Score ≥6.6		Prevalence ratio (95%CI)				p-value
Variables	%*	95%CI	crude		adjusted^†
Total	38.07	(36.23–39.94)
BMI
Eutrophic	35.66	(32.91–38.50)	1		1
Overweight	37.47	(34.48–40.57)	1.05	(0.94–1.17)	1.03	(0.92–1.15)	0.612
Obese	42.04	(38.72–45.43)	1.18	(1.06–1.31)	1.15	(1.03–1.28)	0.010
Hypertension
No	33.73	(31.52–36.01)	1		1
Yes	44.75	(41.97–47.56)	1.33	(1.22–1.45)	1.29	(1.17–1.43)	0.000
Diabetes
No	36.51	(34.58–38.47)	1		1
Yes	46.25	(41.50–51.07)	1.27	(1.13–1.42)	1.21	(1.08–1.36)	0.001
Heart disease
No	37.23	(35.34–39.16)	1		1
Yes	47.79	(41.76–53.89)	1.28	(1.12–1.47)	1.23	(1.07–1.41)	0.004
WMSD
No	37.56	(35.73–39.43)	1		1
Yes	52.14	(41.10–62.98)	1.39	(1.12–1.73)	1.36	(1.10–1.69)	0.004
Lung disease
No	37.65	(35.83–39.51)	1		1
Yes	57.63	(41.76–72.07)	1.53	(1.16–2.02)	1.48	(1.13–1.95)	0.005
Cancer
No	37.87	(36.00–39.79)	1		1
Yes	45.33	(34.07–57.09)	1.20	(0.92–1.56)	1.12	(0.86–1.47)	0.389

Associação Brasileira de Saúde Coletiva Av. Dr. Arnaldo, 715 - 2º andar - sl. 3 - Cerqueira César, 01246-904 São Paulo SP Brasil , Tel./FAX: +55 11 3085-5411 - São Paulo - SP - Brazil
E-mail: revbrepi@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresonding author: Fernanda Cunha de Carvalho. Rua Java, 279, Nova Suíça, CEP 30421-228, Belo Horizonte (MG), Brasil. E-mail: fernandacarvalho0312@gmail.com