Adequacy of care for people with arterial hypertension in Brazil: National Health Survey, 2013 and 2019

Tomasi, Elaine; Pereira, Dario Correia; Santos, Anderson Vaz dos; Neves, Rosália Garcia

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Brasil

Epidemiologia e Serviços de Saúde

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Brasil

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Original article • Epidemiol. Serv. Saúde 31 (2) • 2022 • https://doi.org/10.1590/S2237-96222022000200005 copy

Adequacy of care for people with arterial hypertension in Brazil: National Health Survey, 2013 and 2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze adequacy of care received by adults and elderly people with arterial hypertension, and its association with region of the country, demographic, socioeconomic and health system characteristics in Brazil in 2013 and 2019.

Methods:

This was a cross-sectional study using National Health Survey data. People aged ≥18 years with diagnosis of hypertension and medical consultation for this reason in the last three years were included. Adequacy of care was analyzed based on 11 indicators and using Poisson regression.

Results:

Adequate care was provided to 11,129 people with hypertension (25.3%; 95%CI 24.5;26.1) in 2013 and to 19,107 (18.8%; 95%CI 18.2;19.3) in 2019. Adequate care prevalence was 2.54 (95%CI 2.03;3.17) times higher in 2013, and 3.53 (95%CI 2.94;4.23) times higher in 2019 among individuals belonging to the highest socioeconomic quintile compared to those belonging to the poorest.

Conclusion:

We identified that care decreased, and economic inequalities intensified in the period 2013-2019.

Keywords:
Hypertension; Noncommunicable Diseases; Health Services Research; Quality of Health Care; Cross-Sectional Studies

Variable	2013 (n = 11,129)		2019 (n = 19,107)
Variable	n (%)	Adequate care (%)^a	n (%)	Adequate care (%)^a
Region
Northeast	3,242 (29.1)	20.0	6,639 (34.8)	13.7
North	1,719 (15.5)	22.5	2,983 (15.6)	17.4
Southeast	3,111 (27.9)	27.2	4,867 (25.4)	20.5
South	1,597 (14.4)	22.5	2,545 (13.3)	19.7
Midwest	1,460 (13.1)	27.4	2,073 (10.9)	24.6
Sex
Male	3,898 (35.0)	29.9	7,717 (40.4)	20.7
Female	7,231 (65.0)	21.4	11,390 (59.6)	17.4
Age (years)
18-49	3,441 (30.9)	21.3	4,249 (22.2)	16.0
50-64	4,099 (36.8)	27.7	7,160 (37.5)	21.9
≥65	3,589 (32.3)	23.8	7,698 (40.3)	17.2
Race/skin color
White	4,724 (42.5)	26.5	7,201 (37.7)	21.8
Black	1,159 (10.4)	24.0	2,472 (12.9)	18.5
Brown/Asian/Indigenous	5,246 (47.1)	22.3	9,434 (49.4)	15.7
Economic class (quintiles)
1 (poorest)	2,394 (26.6)	15.3	5,201 (27.2)	9.1
2	2,106 (23.5)	20.8	4,715 (24.7)	15.2
3	1,423 (15.8)	25.7	3,679 (19.3)	18.1
4	1,705 (19.0)	27.9	2,910 (15.2)	24.1
5 (wealthiest)	1,357 (15.1)	39.9	2,602 (13.6)	33.0
Care provision service
Public hospital/UPA^b/PA^c/PS^d	2,466 (22.1)	18.7	3,825 (20.0)	14.5
UBS^e/USF^f	5,513 (49.6)	19.2	9,526 (49.9)	13.2
Private services	3,150 (28.3)	41.1	5,756 (30.1)	29.5
Type of care
SUS^g	7,605 (68.3)	18.8	12,909 (67.7%)	13.4
Non-SUS^g	3,524 (31.7)	35.8	6,161 (32.3%)	29.1
Total	11,129 (100.0)	25.3	19,128 (100.0)	18.8

Variable	2013		2019
	PR^a (95%CI)^b	PR^a (95%CI)^b	PR^a (95%CI)^b	PR^a (95%CI)^b
	Unadjusted	Adjusted	Unadjusted	Adjusted
Region^c	p-value < 0.001^l		p-value < 0.001^l
Northeast	1.00		1.00
North	1.12 (0.90;1.39)		1.27 (1.08;1.50)
Southeast	1.36 (1.14;1.62)		1.49 (1.29;1.73)
South	1.12 (0.91;1.38)		1.44 (1.24;1.67)
Midwest	1.37 (1.14;1.64)		1.79 (1.53;2.10)
Sex^d	p-value < 0.001^l	p-value < 0.001^l	p-value < 0.001^l	p-value = 0.014^l
Male	1.00	1.00	1.00	1.00
Female	0.72 (0.64;0.81)	0.76 (0.68;0.86)	0.84 (0.76;0.93)	0.88 (0.79;0.97)
Age (years)^d	p-value < 0.001^l	p-value < 0.001^l	p-value < 0.001^l	p-value < 0.001^l
18-49	1.00	1.00	1.00	1.00
50-64	1.30 (1.13;1.50)	1.32 (1.13;1.53)	1.37 (1.17;1.61)	1.38 (1.18;1.61)
≥65	1.12 (0.96;1.31)	1.28 (1.08;1.52)	1.08 (0.92;1.27)	1.16 (1.00;1.37)
Race/skin color^d	p-value=0.041^l	p-value=0.890^l	p-value < 0.001^l	p-value=0.090^l
White	1.00	1.00	1.00	1.00
Black	0.91 (0.74;1.11)	1.05 (0.84;1.33)	0.85 (0.72;1.00)	1.05 (0.89;1.23)
Brown/Asian/Indigenous	0.84 (0.74;0.96)	0.99 (0.86;1.15)	0.72 (0.64;0.81)	0.90 (0.80;1.02)
Economic class (quintiles)^d	p-value < 0.001^l	p-value < 0.001^l	p-value < 0.001^l	p-value < 0.001^l
1 (poorest)	1.00	1.00	1.00	1.00
2	1.36 (1.08;1.71)	1.35 (1.07;1.70)	1.68 (1.40;2.01)	1.63 (1.36;1.96)
3	1.68 (1.35;2.09)	1.65 (1.32;2.07)	2.00 (1.68;2.38)	1.93 (1.62;2.31)
4	1.83 (1.48;2.25)	1.80 (1.45;2.24)	2.66 (2.20;3.23)	2.58 (2.12;3.13)
5 (wealthiest)	2.60 (2.10;3.22)	2.54 (2.03;3.17)	3.64 (3.04;4.35)	3.53 (2.94;4.23)
Care provision service^e	p-value < 0.001^l	p-value = 0.043^l	p-value < 0.001^l	p-value = 0.377^l
Public hospital/UPA^f/PA^g/PS^h	1.00	1.00	1.00	1.00
UBSⁱ/USF^j	1.04 (0.85;1.26)	1.03 (0.84;1.27)	0.91 (0.77;1.09)	0.96 (0.81;1.14)
Private services	2.05 (1.71;2.45)	1.48 (1.11;1.98)	2.04 (1.74;2.38)	1.22 (0.90;1.66)
Type of care^e	p-value < 0.001^l	p-value = 0.117^l	p-value < 0.001^l	p-value < 0.053^l
SUS^k	1.00	1.00	1.00	1.00
Non-SUS^k	1.91 (1.68;2.16)	1.14 (0.86;1.52)	2.17 (1.94;2.42)	1.35 (1.00;1.82)

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
Rosália Garcia Neves rosaliagarcianeves@gmail.com