Demand and use of health services by Brazilian adolescents, according to the National School Health Survey 2019

Silva, Alanna Gomes da; Gomes, Crizian Saar; Ferreira, Alan Cristian Marinho; Malta, Deborah Carvalho

doi:10.1590/1980-549720230008.supl.1

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Revista Brasileira de Epidemiologia

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Original Article • Rev. bras. Epidemiol. 26 (Suppl 1) • 2023 • https://doi.org/10.1590/1980-549720230008.supl.1 copy

Demand and use of health services by Brazilian adolescents, according to the National School Health Survey 2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the demand and use of health services by Brazilian adolescents, according to sociodemographic characteristics.

Methods:

Cross-sectional study with data from the 2019 National School Health Survey, that assessed 124,898 adolescents aged 13 to 17 years. The crude and adjusted prevalence ratios (RPaj) by sex, age, and school administrative status and their 95% confidence intervals (95%CI) were calculated for the variables “search for a service or health professional”, “search for a Basic Health Unit” and “assistance at the Basic Health Unit”, using Poisson regression with robust variance.

Results:

The demand for a health service was reported by 56.56% (95%CI 55.82–57.29) of the adolescents and was lower among male students (RPaj: 0.95; 95%CI 0.94–0.95); those with black skin color (RPaj: 0.95; 95%CI 0.94–0.97), brown skin color (RPaj: 0.97; 95%CI 0.96–0.98), yellow skin color and indigenous ethnicity (RPaj: 0.95; 95%CI 0.94–0.97); public school students (RPaj: 0.90; 95%CI 0.89–0.90); and rural residents (RPaj: 0.96; 95%CI 0.94–0.98). A Basic Health Unit was the service sought by 74.08% (95%CI 73.21–74.94) of adolescents, more frequently among students of brown skin color (RPaj: 1.06; 95%CI 1.03–1.08), from public schools (RPaj: 1.32; 95%CI 1.29–1.35) and residing in rural areas (RPaj: 1.05; 95%CI 1,01–1,09). The main reason for seeking the Basic Health Unit was vaccination (27,93%; 95%CI 27,07–28,81).

Conclusion:

More than half of the adolescents searched for a health service, which means that this group has a high demand. However, health inequalities still persist and point to the importance of health care planning, reception conditions, and the quality of care provided.

Keywords:
Adolescent health; Health services accessibility; Unified health system; Health promotion

		Search for a health service or professional		PRc (95%CI)	PRa (95%CI)
		Yes % (95%CI)	No % (95%CI)	PRc (95%CI)	PRa (95%CI)
Total		56.56 (55.82– 57.29)	43.44 (42.71–44.18)
Sex
	Female	60.72 (59.85–61.58)	39.28 (38.42–40.15)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	Male	52.23 (51.27–53.19)	47.77 (46.81–48.73)	0.95 (0.94–0.95)	0.95 (0.94–0.95)
Age (years)
	13–15	55.12 (54.08–56.14)	44.88 (43.86–45.92)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	16–17	59.20 (58.28–60.12)	40.8 (39.88–41.72)	1.03 (1.02–1.04)	1.03 (1.02–1.04)
Skin color
	White	61.25 (60.16–62.34)	38.75(37.66–39.84)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	Black	51.45 (49.64–53.25)	48.55 (46.75–50.36)	0.94 (0.93–0.95)	0.95 (0.94–0.97)
	Brown	55.03 (54.03–56.02)	44.97 (43.98–45.97)	0.96 (0.95–0.97)	0.97 (0.96–0.98)
	Others	51.93 (49.57–54.27)	48.07 (45.73–50.43)	0.94 (0.93–0.96)	0.95 (0.94–0.97)
Status
	Private	71.55(70.73–72.36)	28.45 (27.64–29.27)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	Public	54.02 (53.16.54.87)	45.98 (45.13–46.84)	0.90 (0.89–0.90)	0.90 (0.89–0.90)
Residence area
	Urban	57.27 (56.50–58.04)	42.73 (41.96–43.5)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	Rural	47.9 (45.13–50.68)	52.1 (49.32–54.87)	0.94 (0.92–0.96)	0.96 (0.94–0.98)

		Searched for a Basic Health Unit		PRc (95%CI)	PRa (95%CI)
		Yes % (95%CI)	No % (95%CI)	PRc (95%CI)	PRa (95%CI)
Total		74.08 (73.21–74.94)	25.92 (25.06–26.79)
Sex
	Female	76.17 (75.12–77.2)	23.83 (22.8–24.88)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	Male	71.53 (70.34–72.69)	28.47 (27.31–29.66)	0.94 (0.92–0.96)	0.94 (0.92–0.96)
Age (years)
	13–15	74.03 (72.98–75.06)	25.97 (24.94–27.02)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	16–17	74.17 (72.79–75.51)	25.83 (24.49–27.21)	1.00 (0.98–1.02)	0.99 (0.97–1.01)
Skin color
	White	70.7 (69.4–71.97)	29.3 (28.03–30.6)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	Black	72.94 (70.48–75.27)	27.06 (24.73–29.52)	1.03 (1.00–1.07)	0.99 (0.96–1.03)
	Brown	77.27 (76.06–78.44)	22.73 (21.56–23.94)	1.09 (1.07–1.12)	1.06 (1.03–1.08)
	Others	75.0 (72.24–77.57)	25.0 (22.43–27.76)	1.06 (1.02–1.10)	1.03 (0.99–1.07)
Status
	Private	58.5 (57.41–59.58)	41.5 (40.42–42.59)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	Public	77.04 (76.02–78.04)	22.96 (21.96–23.98)	1.32 (1.29–1.35)	1.32 (1.29–1.35)
Residence area
	Urban	73.65 (72.73–74.54)	26.35 (25.46.27.27)	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status	^* * Reference group for calculating the prevalence ratio. %: prevalence; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status
	Rural	79.86 (76.86–82.55)	20.14 (17.45–23.14)	1.08 (1.04–1.13)	1.05 (1.01–1.09)

		Assisted at Basic Health Unit		PRc (95%CI)	PRa (95%CI)
		Yes % (95%CI)	No % (95%CI)	PRc (95%CI)	PRa (95%CI)
Total		88.61 (88.05–89.14)	11.39 (10.86–11.95)
Sex
	Female	89. 31 (88.54–90.03)	10.69 (9.972–11.46)	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.
	Male	87.73 (86.8–88.6)	12.27 (11.4–13.2)	0.98 (0.97–1.00)	0.98 (0.97–0.99)
Age (years)
	13–15	88.59 (87.9–89.24)	11.41 (10.76–12.1)	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.
	16–17	88.65 (87.71–89.52)	11.35 (10.48–12.29)	1.00 (0.99–1.01)	1.00 (0.99–1.01)
Skin color
	White	89.04 (88.14–89.87)	10.96 (10.13–11.86)	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.
	Black	86.89 (85.12–88.48)	13.11 (11.52–14.88)	0.98 (0.95–1.00)	0.98 (0.95–0.99)
	Brown	88.84 (87.98–89.65)	11.16 (10.35–12.02)	1.00 (0.98–1.01)	1.00 (0.98–1.01)
	Others	87.82 (85.64–89.71)	12.18 (10.29–14.36)	0.99 (0.98–1.01)	0.99 (0.96–1.01)
Status
	Private	88.81 (88.11–89.47)	11.19 (10.53–11.89)	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.
	Public	88.57 (87.92–89.19)	11.43 (10.81–12.08)	1.00 (0.99–1.01)	1.00 (0.99–1.01)
Residence area
	Urban	88.65 (88.07–89.19)	11.35 (10.81–11.93)	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.	^* * Reference group for calculating the prevalence ratio; %: percentage; 95%CI: 95% confidence interval; PRc: crude prevalence ratio; PRa: prevalence ratio adjusted for sex, age and school status.
	Rural	88.17 (85.65–90.3)	11.83 (9.70–14.35)	0.99 (0.97–1.02)	1.00 (0.97–1.02)

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[1] Corresponding author: Alanna Gomes da Silva. Avenida Professor Alfredo Balena, 190, Santa Efigênia, CEP: 30130-100, Belo Horizonte (MG), Brazil. E-mail: alannagomessilva@gmail.com