Supply and demand of procedures related to diabetes mellitus and its complications in Brazil

Muzy, Jéssica; Campos, Monica Rodrigues; Emmerick, Isabel; Sabino, Raulino

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FREE THEMES • Ciênc. saúde coletiva 27 (04) • Apr 2022 • https://doi.org/10.1590/1413-81232022274.05612021 copy

Supply and demand of procedures related to diabetes mellitus and its complications in Brazil

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Abstract

This article aims to present a methodology for monitoring the procedures recommended in the care protocol for diabetic patients, based on the indicator of the ratio between supply and demand for exams, according to Brazil, macro-regions, federative units (FUs), and municipalities. The prevalence of diabetes mellitus (DM) and its complications were estimated using a multinomial model. The offer of DM procedures was obtained from the Ambulatory Information System (SIA/SUS) and the demand from the number of tests defined in the protocol as necessary per year, according to disease risk categories. Based on this, the supply-demand ratio indicator was created. The innovation here consists of analyzing the demand for diabetic care according to established parameters and the supply of health services together. The connection between the recommended treatment protocol and the existence of the service offered concerning the demand for care based on the prevalence of the disease provides a key monitoring tool. And, when analyzed together with the indicator of the ratio between supply and demand for procedures, these measures become a proxy for the quality of prevention and care for patients with the disease.

Key words:
Diabetes mellitus type 2; Diabetes complications; Primary health care; Medical examination; Secondary prevention

Scopes	Male (%)	Female (%)	Total (%)
Brazil	8,14	10,21	9,22
Size of municipality
Small	8,17	10,20	9,19
Medium	7,91	9,90	8,98
Large	8,11	10,40	9,37
North	5,41	7,11	6,25
Rondônia	5,47	6,82	6,13
Acre	5,40	7,03	6,22
Amazonas	5,19	6,76	5,97
Roraima	5,27	6,49	5,86
Pará	5,45	7,34	6,39
Amapá	5,01	6,43	5,72
Tocantins	5,85	7,53	6,68
Northeast	9,53	14,65	12,24
Maranhão	5,47	8,15	6,85
Piauí	5,71	8,66	7,26
Ceará	5,65	8,72	7,28
Rio Grande do Norte	5,51	8,62	7,16
Paraíba	5,78	9,17	7,60
Pernambuco	11,21	17,29	14,50
Alagoas	13,81	21,22	17,76
Sergipe	13,79	21,06	17,66
Bahia	13,76	21,04	17,57
Southeast	12,63	13,01	12,83
Minas Gerais	8,36	8,72	8,55
Espírito Santo	7,92	8,22	8,08
Rio de Janeiro	8,34	8,85	8,61
São Paulo	16,70	17,06	16,89
South	6,89	7,43	7,18
Paraná	6,36	6,89	6,64
Santa Catarina	6,05	6,77	6,42
Rio Grande do Sul	7,87	8,29	8,09
Midwest	6,24	8,85	7,58
Mato Grosso do Sul	6,66	9,34	8,03
Mato Grosso	6,20	8,61	7,38
Goiás	6,49	9,11	7,83
Distrito Federal	5,21	8,10	6,77
Complications by DM
Neuropathy	2,57	3,40	3,00
Retinopathy	1,55	2,04	1,80
Blindness	0,02	0,02	0,02
Diabetic foot (incidence)	0,37	0,20	0,28
Amputation (incidence)	0,04	0,02	0,03
Nephropathy (incidence)	0,02	0,01	0,01

Region		P1	P2	P3	P4	P5	P6
NO	Prevalence of DM = 6,25
	Estimated demand of DM Pr	481.929	341.366	341.366	341.366	341.366	963.857
	% of Pr offer to DM on SUS	56,2	58,4	58,4	58,4	58,4	96,6
	Total offer of DM Pr*	2.401.702	1.453.405	804.976	759.804	1.347.372	130.771
	Ratio supply/demand	5,0	4,3	2,4	2,2	3,9	0,1
NE	Prevalence of DM = 12,24
	Estimated demand of DM Pr	3.578.149	2.534.522	2.534.522	2.534.522	2.534.522	7.156.298
	% of Pr offer to DM on SUS	54,5	56,6	56,6	56,6	56,6	96,1
	Total offer of DM Pr*	5.435.656	3.801.751	2.369.933	2.229.438	3.320.939	538.738
	Ratio supply/demand	1,5	1,5	0,9	0,9	1,3	0,1
SE	Prevalence of DM = 12,83
	Estimated demand of DM Pr	6.584.095	4.663.734	4.663.734	4.663.734	4.663.734	13.168.190
	% of Pr offer to DM on SUS	56,2	58,4	58,4	58,4	58,4	97,4
	Total offer of DM Pr*	15.860.128	10.828.245	8.480.672	6.311.229	9.928.540	4.619.869
	Ratio supply/demand	2,4	2,3	1,8	1,4	2,1	0,4
SU	Prevalence of DM = 7,18
	Estimated demand of DM Pr	1.252.983	887.529	887.529	887.529	887.529	2.505.965
	% of Pr offer to DM on SUS	47,0	47,6	47,6	47,6	47,6	96,7
	Total offer of DM Pr*	4.030.397	2.779.918	2.029.903	1.358.537	2.533.756	1.063.047
	Ratio supply/demand	3,2	3,1	2,3	1,5	2,9	0,4
CO	Prevalence of DM = 7,58
	Estimated demand of DM Pr	522.089	401.607	381.527	381.527	401.607	1.253.056
	% of Pr offer to DM on SUS	56,2	62,1	100,0	80,9	83,1	96,4
	Total offer of DM Pr*	1.184.142	2.884.981	70.575	156.552	417.24	287.387
		2,3	7,2	0,2	0,4	1,0	0,2
Region
NO	Prevalence of DM = 6,25	3.876.328	2.981.791	2.832.701	2.832.701	2.981.791
	Estimated demand of DM Pr	54,5	61,6	100,0	100,0	83,3
	% of Pr offer to DM on SUS	2.959.564	5.289.349	82.614	333.340	1.820.428
	Total offer of DM Pr*	0,8	1,8	0,0	0,1	0,6
	Ratio supply/demand
NE	Prevalence of DM = 12,24	7.132.770	5.486.746	5.212.409	5.212.409	5.486.746
	Estimated demand of DM Pr	56,2	62,0	100,0	100,0	84,1
	% of Pr offer to DM on SUS	12.392.479	15.439.016	535.624	1.402.852	6.503.414
	Total offer of DM Pr*	1,7	2,8	0,1	0,3	1,2
	Ratio supply/demand
Region	Prevalence of DM = 12,83	1.357.398	1.044.152	991.945	991.945	1.044.152
SE	Estimated demand of DM Pr	47,0	61,9	100,0	98,6	83,7
	% of Pr offer to DM on SUS	3.008.316	4.312.923	215.553	560.635	1.763.025
	Total offer of DM Pr*	2,2	4,1	0,2	0,6	1,7
	Ratio supply/demand
	Prevalence of DM = 7,18	678.739	522.107	496.001	496.001	522.107
SU	Estimated demand of DM Pr	48,3	62,0	100,0	100,0	83,9
	% of Pr offer to DM on SUS	1.586.402	2.968.991	90.074	181.413	853.535
	Total offer of DM Pr*	2,3	5,7	0,2	0,4	1,6
	Ratio supply/demand	3.008.316	4.312.923	215.553	560.635	1.763.025
	Prevalence of DM = 7,58	2,2	4,1	0,2	0,6	1,7
CO	Estimated demand of DM Pr
	% of Pr offer to DM on SUS	678.739	522.107	496.001	496.001	522.107
	Total offer of DM Pr*	48,3	62,0	100,0	100,0	83,9
	Ratio supply/demand	1.586.402	2.968.991	90.074	181.413	853.535
	Razão oferta/ demanda	2,3	5,7	0,2	0,4	1,6

Region	Size	P1	P2	P3	P4	P5	P6	P7	P8	P9	P10	P13
NO	P	4,23	3,72	1,60	1,54	3,42	0,09	1,61	6,77	0,15	0,06	0,71
	M	5,24	4,33	2,65	2,25	4,03	0,08	2,53	6,77	0,27	0,34	1,32
	G	6,98	5,64	4,13	4,07	5,33	0,33	3,87	8,81	0,17	1,26	1,62
	Total	4,98	4,26	2,36	2,23	3,95	0,14	2,27	7,18	0,18	0,41	1,04
NE	P	1,25	1,32	0,64	0,60	1,10	0,03	0,45	1,54	0,01	0,15	0,38
	M	1,90	1,84	1,36	1,24	1,66	0,11	1,08	2,35	0,04	0,48	0,78
	G	1,96	1,76	1,40	1,35	1,63	0,17	1,33	2,05	0,07	0,63	1,05
	Total	1,52	1,50	0,94	0,88	1,31	0,08	0,76	1,77	0,03	0,12	0,61
SE	P	2,43	2,43	1,66	1,45	2,24	0,20	1,32	2,83	0,05	0,45	1,30
	M	2,96	2,96	2,37	2,09	2,63	0,43	2,16	3,58	0,11	0,86	1,55
	G	2,78	2,55	2,14	1,21	2,36	0,51	2,34	3,00	0,17	0,80	1,19
	Total	2,41	2,32	1,82	1,35	2,13	0,35	1,74	2,81	0,10	0,27	1,19
SU	P	2,58	2,66	1,66	1,05	2,36	0,20	1,37	3,01	0,07	0,32	1,04
	M	3,74	3,53	2,79	1,90	3,20	0,52	2,78	5,11	0,28	0,50	2,37
	G	4,57	4,08	3,66	2,60	4,02	1,11	4,45	6,50	0,69	1,75	2,84
	Total	3,22	3,13	2,29	1,53	2,85	0,42	2,22	4,13	0,22	0,57	1,69
CO	P	2,87	2,67	1,31	1,13	2,28	0,05	1,24	4,55	0,01	0,14	1,25
	M	3,96	3,54	3,07	2,74	3,17	0,24	1,95	5,52	0,25	1,06	1,99
	G	5,60	4,33	3,73	2,87	3,95	0,47	4,08	7,53	0,40	0,79	2,13
		3,96	3,37	2,43	2,00	3,01	0,23	2,34	5,69	0,18	0,37	1,63
Brazil		3,22	2,92	1,97	1,60	2,65	0,24	1,86	4,32	0,14	0,35	1,23

Region	Proc.	Average ratio of the region	Small sized	Ratio	Medium sized	Ratio	Large sized	Ratio
NO	P1	4,98	Itapiranga (AM)	30,27	Tucuruí (PA)	9,99	Manaus (AM)	9,17
	P6	0,14	Borba (AM)	1,95	Parauapebas (PA)	0,28	Manaus (AM)	0,51
	P7	2,27	Itapiranga (AM)	10,80	Rio Branco (AC)	6,51	Manaus (AM)	5,58
	P8	7,18	Acará (PA)	59,27	Parauapebas (PA)	16,57	Manaus (AM)	12,24
	P10	0,41	Porto Nacional (TO)	2,02	Parintins (AM)	1,51	Belém (PA)	1,92
	P13	1,04	Vilhena (RO)	6,30	Altamira (PA)	5,76	Manaus (AM)	2,28
NE	P1	1,52	Fartura do Piauí (PI)	17,96	Sobral (CE)	6,48	São Luís (MA)	4,94
	P6	0,08	Maracaçumé (MA)	1,58	Bacabal (MA)	1,33	Recife (PE)	0,32
	P7	0,76	Bento Fernandes (RN)	12,39	Sobral (CE)	3,57	São Luís (MA)	3,08
	P8	1,77	Brejo de Areia (MA)	24,92	Sobral (CE)	8,31	Lastro (PB)	6,32
	P10	0,12	Independência (CE)	4,39	Campina Grande (PB)	2,39	Recife (PE)	0,78
	P13	0,61	Brejo de Areia (MA)	16,84	Sobral (CE)	4,54	São Luís (MA)	2,38
SE	P1	2,41	Lindóia (SP)	20,84	Angra dos Reis (RJ)	21,09	São Gonçalo (RJ)	11,69
	P6	0,35	Cristália (MG)	2,90	Volta Redonda (RJ)	1,99	Duque de Caxias (RJ)	0,96
	P7	1,74	Quissamã (RJ)	14,78	Angra dos Reis (RJ)	11,75	São Gonçalo (RJ)	4,91
	P8	2,81	Lindóia (SP)	27,84	Angra dos Reis (RJ)	19,68	Duque de Caxias (RJ)	6,73
	P10	0,27	Lindóia (SP)	9,71	Betim (MG)	4,60	Nova Iguaçu (RJ)	1,32
	P13	1,19	Américo Brasiliense (SP)	15,01	Araruama (RJ)	9,77	Uberlândia (MG)	2,40
SU	P1	3,22	São João do Sul (SC)	18,22	Itajaí (SC)	8,81	Londrina (PR)	5,02
	P6	0,42	Cruzmaltina (PR)	4,72	Itajaí (SC)	1,84	Londrina (PR)	1,24
	P7	2,22	Joaçaba (SC)	9,36	Araucária (PR)	6,41	Porto Alegre (RS)	5,47
	P8	4,13	Joaçaba (SC)	19,43	Araucária (PR)	13,31	Londrina (PR)	8,27
	P10	0,57	Três de Maio (RS)	15,88	Passo Fundo (RS)	3,17	Londrina (PR)	5,73
	P13	1,69	Campina Grande do Sul (PR)	9,84	São José (SC)	26,44	Porto Alegre (RS)	3,55
CO	P1	3,96	Portelândia (GO)	19,43	Anápolis (GO)	5,96	Brasília (DF)	7,31
	P6	0,23	Nova Veneza (GO)	1,08	Águas Lindas de Goiás (GO)	0,92	Goiânia (GO)	0,54
	P7	2,34	Chapadão do Céu (GO)	9,04	Anápolis (GO)	3,14	Brasília (DF)	5,62
	P8	5,69	Chapadão do Céu (GO)	41,27	Formosa (GO)	11,99	Goiânia (GO)	8,65
	P10	0,37	Água Fria de Goiás (GO)	8,03	Águas Lindas de Goiás (GO)	7,04	Brasília (DF)	0,89
	P13	1,63	Campinaçu (GO)	10,69	Várzea Grande (MT)	6,24	Goiânia (GO)	3,32

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[1] Collaborations

J Muzy: conception and design of the study, estimation and analysis of data, writing and critical review of the final contente. MR Campos: conception and design of the study, estimation and analysis of data, writing and critical review of the final contente. I Emmerick: data analysis, writing and critical review of the final contente. R Sabino: estimation and analysis of data and critical review of the final content.