Autoevaluación de la salud según sexo y factores asociados en Manaus, Brasil, 2019: estudio transversal de base poblacional

Nakamura, Isabella Bagni; Silva, Marcus Tolentino; Galvão, Taís Freire

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Brasil

Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 33 • 2024 • https://doi.org/10.1590/S2237-96222024V33E2023154.EN copiar

Autoevaluación de la salud según sexo y factores asociados en Manaus, Brasil, 2019: estudio transversal de base poblacional

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

Objetivo:

Analizar la prevalencia y los factores asociados a la mala autoevaluación de salud según sexo en Manaus, Brasil.

Métodos:

Se trata de un estudio poblacional transversal con adultos residentes en Manaus en 2019. Las razones de prevalencia ajustadas (RP) y los intervalos de confianza del 95% (IC_95%) se calcularon mediante regresión jerárquica de Poisson.

Resultados:

Autoevaluación mala de salud ocurrió en 35,2% (IC_95% 33,3;37,2) de los 2.321 participantes y fue mayor en el sexo femenino (RP = 1,27; IC_95%1,13;1,43). En la población general, femenina y masculina, la mala autoevaluación de salud fue mayor entre ancianos, con inseguridad alimentaria moderada y grave y con enfermedades crónicas (p-valor < 0,05). En el sexo femenino, la mala salud fue mayor en evangélicas y con inseguridad alimentaria leve. En el sexo masculino, jubilados y con educación inferior al nivel básico también tuvieron una peor autoevaluación (p-valor < 0,001).

Conclusión:

Personas de sexo femenino tuvieron una peor valoración de salud, influenciada por la morbilidad y el acceso a la alimentación.

Palabras-clave:
Autoevaluación; Desigualdad de Género; Estudios Transversales; Enfermedades crónicas; Inseguridad alimentaria

Variables	Total N (%)	Poor health N (%)	p-value
Sex			< 0.001
Male	1,088 (47.8)	322 (29.3)
Female	1,233 (52.2)	501 (40.7)
Age group (years)			< 0.001
18-24	405 (19.3)	105 (25.6)
25-34	586 (25.1)	160 (27.2)
35-44	553 (22.8)	177 (31.9)
45-59	526 (21.2)	242 (45.9)
≥ 60	251 (11.6)	139 (55.5)
Race/skin color			0.745
White	349 (15.0)	121 (34.5)
Black	1,972 (85.0)	702 (35.4)
Occupation			< 0.001
Formal work	419 (17.9)	110 (26.2)
Informal work	661 (28.1)	222 (33.3)
Retired	162 (7.2)	90 (55.4)
Student/housewife	124 (5.7)	30 (23.7)
Unemployed	955 (41.1)	371 (38.6)
Economic classification			< 0.001
A/B	282 (12.3)	83 (29.2)
C	1,244 (53.6)	414 (33.0)
D/E	795 (34.1)	326 (40.8)
Schooling			< 0.001
Higher education or above	153 (6.5)	42 (27.3)
High school education	1,171 (50.4)	338 (28.5)
Elementary education	432 (18.9)	159 (36.7)
Below elementary	565 (24.2)	284 (50.2)
Religion			0.081
Catholic	931 (39.9)	317 (33.9)
Evangelical	1,054 (45.4)	401 (37.8)
Other	137 (5.9)	43 (31.4)
None	199 (8.8)	62 (30.5)
Food insecurity^a			< 0.001
None	777 (33.8)	204 (26.2)
Mild	874 (37.7)	286 (32.4)
Moderate	319 (13.8)	153 (47.9)
Severe	345 (14.7)	179 (51.4)
Body composition			0.002
Eutrophy	971 (42.6)	322 (32.9)
Overweight	792 (33.8)	296 (33.7)
Obesity	558 (23.6)	232 (41.6)
No. of chronic diseases			< 0.001
0	921 (40.1)	164 (17.8)
1	682 (29.3)	218 (31.8)
≥ 2	718 (30.6)	441 (61.4)

Variables	Unadjusted PR (95%CI)	p-value	Adjusted PR (95%CI)	p-value
First level
Sex		< 0.001		< 0.001
Male	1.00		1.00
Female	1.39 (1.24;1.56)		1.27 (1.13;1.43)
Age group (years)		< 0.001		< 0.001
18-24	1.00		1.00
25-34	1.06 (0.86;1.31)		1.10 (0.88;1.36)
35-44	1.25 (1.02;1.53)		1.26 (1.01;1.56)
45-59	1.79 (1.48;2.17)		1.78 (1.45;2.19)
≥ 60	2.17 (1.78;2.64)		1.85 (1.46;2.34)
Race/skin color		0.746
White	1.00
Black	1.03 (0.88;1.20)
Occupation		< 0.001		0.057
Formal work	1.00		1.00
Informal work	1.27 (1.05;1.54)		1.06 (0.87;1.29)
Retired	2.11 (1.71;2.62)		1.29 (1.02;1.64)
Student/housewife	0.91 (0.64;1.29)		1.02 (0.70;1.48)
Unemployed	1.47 (1.23;1.77)		1.23 (1.02;1.49)
Economic classification		< 0.001		0.600
A/B	1.00		1.00
C	1.13 (0.93;1.38)		0.99 (0.81;1.20)
D/E	1.40 (1.15;1.71)		1.05 (0.85;1.29)
Schooling		< 0.001		< 0.001
Higher education or above	1.00		1.00
High school education	1.05 (0.79;1.37)		1.05 (0.80;1.38)
Elementary education	1.34 (1.01;1.79)		1.34 (1.00;1.79)
Below elementary	1.84 (1.40;2.42)		1.45 (1.09;1.92)
Religion		0.085		0.060
Catholic	1.00		1.00
Evangelical	1.12 (0.99;1.26)		1.17 (1.04;1.31)
Other	0.93 (0.71;1.21)		1.05 (0.81;1.37)
None	0.90 (0.72;1.13)		1.14 (0.91;1.44)
Second level
Food insecurity		< 0.001		< 0.001
None	1.00		1.00
Mild	1.24 (1.06;1.44)		1.22 (1.05;1.41)
Moderate	1.83 (1.55;2.16)		1.70 (1.45;1.99)
Severe	1.96 (1.68;2.30)		1.67 (1.43;1.95)
Body composition		0.001		0.067
Eutrophy	1.00		1.00
Overweight	1.02 (0.90;1.17)		1.02 (0.90;1.16)
Obesity	1.27 (1.11;1.45)		1.16 (1.01;1.32)
Third level
No. of chronic diseases		< 0.001		< 0.001
0	1.00		1.00
1	1.79 (1.50;2.14)		1.71 (1.44;2.04)
≥ 2	3.46 (2.97;4.02)		2.90 (2.47;3.40)

Variables	Female sex (N = 1,233)				Male sex (N = 1,088)
Variables	Unadjusted PR (95%CI)	p-value	Adjusted PR (95%CI)	p-value	Unadjusted PR (95%CI)	p-value	Adjusted PR (95%CI)	p-value
First level
Age group (years)		< 0,001		< 0.001		< 0.001		0.005
18-24	1.00		1.00		1.00		1.00
25-34	1.01 (0.79;1.31)		1.04 (0.80;1.35)		1.13 (0.78;1.63)		1.16 (0.79;1.69)
35-44	1.08 (0.84;1.39)		1.13 (0.86;1.47)		1.51 (1.07;2.13)		1.45 (1.00;2.10)
45-59	1.66 (1.33;2.08)		1.75 (1.37;2.25)		1.97 (1.42;2.75)		1.75 (1.23;2.50)
≥ 60	1.88 (1.48;2.39)		1.83 (1.39;2.42)		2.57 (1.82;3.63)		1.78 (1.17;2.71)
Race/skin color		0.688				0.513
White	1.00		1.00		1.00		1.00
Black	0.96 (0.80;1.16)				1.09 (0.84;1.42)
Occupation		0.002		0.339		< 0.001
Formal work	1.00		1.00		1.00		1.00	0.127
Informal work	1.26 (0.94;1.71)		1.06 (0.78;1.44)		1.22 (0.94;1.57)		1.03 (0.80;1.34)
Retired	1.82 (1.31;2.53)		1.18 (0.83;1.68)		2.25 (1.70;2.98)		1.42 (1.01;2.02)
Student/housewife	1.03 (0.67;1.59)		1.19 (0.75;1.88)		0.60 (0.31;1.18)		0.76 (0.37;1.53)
Unemployed	1.36 (1.03;1.79)		1.24 (0.93;1.64)		1.23 (0.93;1.62)		1.21 (0.92;1.60)
Economic classification		0.037		0.722		0.008		0.454
A/B	1.00		1.00		1.00		1.00
C	1.18 (0.90;1.54)		1.10 (0.84;1.44)		1.02 (0.76;1.37)		0.86 (0.64;1.16)
D/E	1.35 (1.03;1.77)		1.12 (0.85;1.49)		1.37 (1.01;1.85)		0.96 (0.70;1.31)
Schooling		< 0.001		0.010		< 0.001		0.002
Higher education or above	1.00		1.00		1.00		1.00
High school education	1.01 (0.74;1.39)		0.96 (0.69;1.32)		1.19 (0.71;1.98)		1.25 (0.75;2.07)
Elementary education	1.32 (0.95;1.84)		1.23 (0.88;1.72)		1.47 (0.86;2.52)		1.60 (0.93;2.74)
Below elementary	1.61 (1.17;2.20)		1.23 (0.88;1.70)		2.38 (1.43;3.95)		1.94 (1.15;3.29)
Religion		0.067		0.016		0.887
Catholic	1.00		1.00		1.00		1.00
Evangelical	1.18 (1.02;1.37)		1.26 (1.09;1.46)		0.94 (0.76;1.15)
Other	1.01 (0.71;1.45)		1.08 (0.75;1.56)		0.89 (0.60;1.30)
None	0.88 (0.64;1.21)		1.11 (0.80;1.54)		0.94 (0.68;1.30)
Second level
Food insecurity		< 0.001		< 0.001		< 0.001		< 0.001
None	1.00		1.00		1.00		1.00
Mild	1.35 (1.09;1.65)		1.33 (1.09;1.62)		1.06 (0.84;1.34)		1.10 (0.88;1.38)
Moderate	1.87 (1.50;2.33)		1.74 (1.40;2.15)		1.68 (1.29;2.18)		1.69 (1.31;2.18)
Severe	2.14 (1.75;2.63)		1.87 (1.52;2.30)		1.57 (1.20;2.05)		1.44 (1.10;1.87)
Body composition		0.079		0.359		0.061		0.167
Eutrophy	1.00		1.00		1.00		1.00
Overweight	0.99 (0.84;1.17)		0.99 (0.84;1.16)		1.09 (0.88;1.35)		1.04 (0.85;1.28)
Obesity	1.17 (1.00;1.37)		1.10 (0.94;1.28)		1.32 (1.05;1.67)		1.24 (0.98;1.57)
Third level
No. of chronic diseases		< 0.001		< 0.001		< 0.001		< 0.001
0	1.00		1.00		1.00		1.00
1	1.67 (1.33;2.09)		1.61 (1.29;2.00)		1.90 (1.43;2.53)		1.80 (1.36;2.39)
≥ 2	2.75 (2.27;3.33)		2.37 (1.94;2.89)		4.44 (3.49;5.65)		3.84 (2.97;4.90)

Variables	Female sex (N = 1,233)			Male sex (N = 1,088)
Variables	Total n (%)	Poor health n (%)	p-value	Total n (%)	Poor health n (%)	p-value
Age group (years)			< 0.001			< 0.001
18-24	213 (18.5)	68 (31.9)		192 (20.1)	37 (19.3)
25-34	306 (24.8)	99 (32.4)		280 (25.5)	61 (21.8)
35-44	295 (22.9)	102 (34.6)		258 (22.8)	75 (29.1)
45-59	279 (21.2)	148 (53.1)		247 (21.1)	94 (38.1)
≥ 60	140 (12.6)	84 (60.0)		111 (10.5)	55 (49.6)
Race/skin color			0.691			0.507
White	174 (14.1)	73 (42.0)		175 (16.1)	48 (27.2)
Black	1,059 (85.9)	428 (40.4)		913 (83.9)	274 (29.7)
Occupation			0.003			< 0.001
Formal work	126 (10.0)	39 (30.9)		293 (26.6)	71 (24.2)
Informal work	268 (21.3)	105 (39.1)		393 (35.5)	117 (29.5)
Retired	76 (6.5)	43 (56.2)		86 (7.9)	47 (54.6)
Student/housewife	69 (5.9)	22 (31.8)		55 (5.6)	8 (14.5)
Unemployed	694 (56.3)	292 (42.1)		261 (24.4)	79 (29.8)
Economic classification			0.033			0.009
A/B	126 (10.2)	42 (33.2)		156 (14.4)	41 (26.0)
C	651 (52.9)	255 (39.2)		593 (54.4)	159 (26.5)
D/E	456 (36.9)	204 (44.9)		339 (31.2)	122 (35.6)
Schooling			< 0.001			< 0.001
Higher education or above	87 (7.0)	29 (33.3)		66 (5.9)	13 (19.5)
High school education	605 (48.8)	205 (33.8)		566 (52.2)	133 (23.1)
Elementary education	230 (18.9)	101 (44.0)		202 (18.9)	58 (28.6)
Below elementary	311 (25.3)	166 (53.5)		254 (23.0)	118 (46.3)
Religion			0.059			0.887
Catholic	454 (36.8)	170 (37.5)		477 (43.4)	147 (30.5)
Evangelical	636 (51.6)	281 (44.2)		418 (38.6)	120 (28.6)
Other	56 (4.5)	21 (38.1)		81 (7.4)	22 (27.0)
None	87 (7.1)	29 (33.0)		112 (10.6)	33 (28.7)
Food insecurity^a			< 0.001			< 0.001
None	345 (28.2)	95 (27.8)		432 (39.9)	109 (25.0)
Mild	484 (39.3)	181 (37.4)		390 (35.9)	105 (26.5)
Moderate	191 (15.5)	99 (52.0)		128 (11.8)	54 (42.0)
Severe	211 (17.0)	126 (59.6)		134 (12.4)	53 (39.2)
Body composition			0.089			0.068
Eutrophy	499 (41.0)	194 (39.0)		472 (44.3)	128 (26.8)
Overweight	392 (31.6)	151 (38.5)		400 (36.2)	118 (29.1)
Obesity	342 (27.4)	156 (45.7)		216 (19.5)	76 (35.4)
No. of chronic diseases			< 0.001			< 0.001
0	433 (35.3)	96 (22.3)		488 (45.4)	68 (13.9)
1	349 (28.2)	129 (37.1)		333 (30.5)	89 (26.5)
≥ 2	451 (36.5)	276 (61.2)		267 (2)	165 (61.8)

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:
Taís Freire Galvão.
E-mail:
taisgalvao@gmail.com