Prevalence of chronic diseases and access to health services in Brazil: evidence of three household surveys

Simões, Taynãna César; Meira, Karina Cardoso; Santos, Juliano dos; Câmara, Daniel Cardoso Portela

doi:10.1590/1413-81232021269.02982021

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ARTICLE • Ciênc. saúde coletiva 26 (09) • Sept 2021 • https://doi.org/10.1590/1413-81232021269.02982021 copy

Prevalence of chronic diseases and access to health services in Brazil: evidence of three household surveys

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Chronic non-communicable diseases (NCDs) are the leading causes of death globally, impacting heavily on the most vulnerable populations. This study aimed to analyze changes in the prevalence of these diseases, health conditions, access, and health services in Brazil between 2008 and 2019. Tests of differences and generalized linear models were used as analytical tools, considering complex sampling from the PNAD 2008, PNS 2013, and PNS 2019 surveys, to test temporal changes in the prevalence and the prevalence ratio estimates, adjusted by sociodemographic variables. An increase in the prevalence of Depression, Diabetes, Cancers, Neuropsychiatric Disorders, Chronic Pulmonary problems, and Musculoskeletal problems was observed. A decline in rheumatoid arthritis, chronic renal failure, and diseases of the circulatory system was identified. Among Brazilians with at least one NCD, an increase in coverage by the family health strategy over time was observed. However, there was a reduction in timely medical care and obtaining of free prescription drugs.

Key words:
Chronic noncommunicable diseases; Surveys; Generalized linear models; Access to health

Variables	PNAD2008	PNS2013	PNS2019	p-value	PR (95% CI)
Variables					2013 vs. 2008	2019 vs. 2008 (2013) **
At least one NCD ¹	22.04 (21.78-22.31)	24.46 (23.83-25.10)	29.52 (28.96-30.09)	< 0.0001	1.07 (1.04-1.10)	1.22 (1.19-1.25)
Circulatory System Diseases (CSD)
General CSD ²	5.33 (5.21-5.44)	4.18 (3.85-4.51)	5.30 (5.03-5.57)	< 0.0001	0.73 (0.68-0.79)	0.85 (0.80-0.90)
Heart attack	-	1.27 (1.10-1.44)	1.56 (1.42-1.69)	0.0123	-	1.10 (0.94-1.28)
Angina	-	0.75 (0.64-0.86)	0.8 (0.71-0.90)	0.4867	-	0.97 (0.80-1.17)
Heart failure	-	1.16 (1.01-1.31)	1.13 (1.00-1.25)	0.7272	-	0.88 (0.74-1.03)
Stroke	-	1.53 (1.35-1.70)	1.96 (1.81-2.11)	0.0003	-	1.15 (1.00-1.31)
Neuropsychiatric Disorders (NPD)
Depression	5.74 (5.59-5.88)	7.64 (7.22-8.06)	10.24 (9.85-10.62)	< 0.0001	1.31 (1.23-1.39)	1.71 (1.64-1.79)
Schizophrenia	-	0.23 (0.16-0.30)	0.34 (0.29-0.40)	0.0205	-	1.49 (1.06-2.10)
Bipolar disorder	-	0.40 (0.31-0.49)	0.62 (0.54-0.71)	0.0012	-	1.58 (1.21-2.05)
OCD	-	0.17 (0.12-0.22)	0.41 (0.33-0.50)	< 0.0001	-	2.47 (1.70-3.60)
One or more NPD³	-	0.63 (0.52-0.74)	1.15 (1.03-1.27)	< 0.0001	-	1.84 (1.50-2.26)
Neoplasms (CA)
Some cancer	0.77 (0.73-0.82)	1.83 (1.63-2.03)	2.56 (2.38-2.74)	< 0.0001	2.20 (1.96-2.48)	2.79 (2.56-3.05)
Skin	-	0.30 (0.23-0.36)	0.52 (0.44-0.59)	< 0.0001	-	1.55 (1.19-2.02)
Lung	-	0.02 (0.01-0.04)	0.08 (0.05-0.11)	< 0.0001	-	3.04 (1.60-5.78)
Intestine	-	0.15 (0.08-0.21)	0.16 (0.12-0.20)	0.6842	-	0.98 (0.59-1.63)
Stomach	-	0.05 (0.02-0.09)	0.07 (0.04-0.10)	0.5226	-	1.16 (0.55-2.46)
Breast	-	0.80 (0.60-0.99)	1.16 (0.98-1.34)	0.0096	-	1.34 (1.01-1.78)
Cervical	-	0.24 (0.15-0.33)	0.51 (0.40-0.61)	0.0003	-	2.03 (1.34-3.06)
Prostate	-	0.59 (0.44-0.74)	0.79 (0.65-0.93)	0.0631	-	1.13 (0.84-1.53)
Other Chronic Diseases (Other NCDs)
Some lung ⁴	-	1.78 (1.59-1.98)	1.66 (1.49-1.84)	0.3700	-	0.89 (0.77-1.04)
Asthma or Bronchitis	4.01 (3.92-4.11)	4.40 (4.10-4.70)	5.27 (4.99-5.55)	< 0.0001	1.10 (1.02-1.18)	1.32 (1.24-1.40)
Diabetes	5.00 (4.90-5.10)	6.50 (6.15-6.84)	8.04 (7.74-8.35)	< 0.0001	1.21 (1.14-1.28)	1.36 (1.30-1.42)
Rheumatoid arthritis	7.94 (7.77-8.11)	6.41 (6.07-6.76)	7.57 (7.23-7.91)	< 0.0001	0.75 (0.71-0.79)	0.81 (0.77-0.85)
Spine/back chronic problems⁵	-	18.47 (17.84-19.10)	21.58 (21.02-22.13)	< 0.0001	-	1.12 (1.08-1.17)
WMSD	-	2.44 (2.19-2.68)	2.51 (2.26-2.75)	0.6993	-	1.03 (0.89-1.18)
CRF ⁶	1.71 (1.63-1.79)	1.42 (1.26-1.59)	1.47 (1.33-1.60)	0.0142	0.80 (0.71-0.91)	0.78 (0.71-0.87)

Variables	Prevalence (95%CI)			Adjusted prevalence ratio (95%CI)
Variables	2008	2013	2019	P-valor	2013 vs 2008	2019 vs 2008
Self-assessed health status (Very Good/Good)	37.31 (36.73-37.88)	44.23 (42.79-45.67)	47.11 (45.96-48.27)	< 0.0001	1.17 (1.13-1.21)	1.27 (1.23-1.30)
Limited routine activities	20.18 (19.72-20.64)	15.89 (14.87-16.92)	16.46 (15.70-17.22)	< 0.0001	0.79 (0.74-0.84)	0.81 (0.77-0.86)
Bedridden	50.18 (49.06-51.29)	45.83 (42.46-49.21)	35.92 (33.57-38.27)	< 0.0001	0.91 (0.84-0.98)	0.71 (0.66-0.76)
Has health insurance plan	29.63 (28.90-30.35)	34.44 (32.81-36.06)	33.3 (32.12-34.49)	< 0.0001	1.16 (1.10-1.22)	1.12 (1.07-1.17)
ESF coverage ¹	49.86 (48.71-51.01)	61.9 (59.95-63.86)	69.15 (67.62-70.68)	< 0.0001	1.24 (1.20-1.29)	1.39 (1.35-1.43)
Seeks the same service or doctor	78.91 (78.27-79.54)	81.60 (80.36-82.84)	78.97 (78.02-79.91)	0.0003	1.03 (1.02-1.05)	1.00 (0.99-1.01)
Medical visit in 12 months	87.45 (87.12-87.79)	89.3 (88.47-90.14)	92.66 (92.14-93.19)	< 0.0001	1.02 (1.01-1.03)	1.06 (1.05-1.06)
Seeking medical care in the last two weeks	29 (28.48-29.53)	30.31 (28.94-31.69)	34.86 (33.83-35.88)	< 0.0001	1.04 (0.99-1.10)	1.2 (1.16-1.24)
Received care at the 1st attempt	96.02 (95.68-96.36)	95.39 (94.43-96.35)	65.19 (63.32-67.07)	< 0.0001	0.99 (0.98-1.00)	0.68 (0.66-0.70)
Received care at the 2nd attempt	62.26 (56.95-67.58)	58.84 (45.58-72.09)	88.72 (85.97-91.46)	< 0.0001	0.93 (0.73-1.18)	1.38 (1.26-1.52)
Performed in public service	61.1 (60.02-62.18)	60.29 (57.45-63.13)	59.41 (57.17-61.64)	0.5339	0.99 (0.94-1.04)	0.97 (0.93-1.01)
Performed in the SUS	59.33 (58.23-60.43)	58.81 (56.00-61.62)	57.14 (54.87-59.40)	0.3269	0.99 (0.94-1.04)	0.96 (0.92-1.00)
Performed through health plan	25.62 (24.66-26.59)	28.64 (25.99-31.30)	29.78 (27.77-31.79)	0.0273	1.12 (1.01-1.23)	1.17 (1.08-1.26)
Performed against the payment of some amount	17.7 (16.96-18.45)	16.81 (14.80-18.81)	18.31 (16.82-19.80)	0.3445	0.95 (0.83-1.07)	1.05 (0.95-1.14)
Prescribed medication in the last two weeks	66.91 (65.99-67.82)	69.73 (67.21-72.25)	63.62 (61.55-65.68)	0.0001	1.04 (1.00-1.08)	0.95 (0.92-0.99)
Obtaining any medication prescribed in the last two weeks
Through the health plan	-	6.86 (5.34-8.37)	3.57 (2.54-4.60)	0.0003	-	0.90 (0.85-0.95)
Paid some amount	-	78.93 (75.78-82.09)	78.55 (76.04-81.07)	0.8541	-	0.99 (0.94-1.04)
Through the PFP ²	-	31.39 (28.30-34.49)	25.88 (23.38-28.39)	0.0063	-	0.83 (0.73-0.95)
Public service	-	51.21 (47.53-54.90)	42.76 (40.02-45.50)	0.0003	-	0.84 (0.76-0.92)
Hospitalization in the last 12 months	15.07 (14.72-15.43)	12.12 (11.23-13.02)	13.49 (12.44-14.54)	0.0002	0.81 (0.75-0.87)	0.89 (0.82-0.97)
Health plan	27.06 (25.80-28.32)	26.54 (22.98-30.11)	28.56 (25.78-31.33)	0.5047	1.00 (0.86-1.15)	1.04 (0.94-1.16)
Paid some amount	10.21 (9.46-10.95)	12.39 (9.70-15.08)	11.69 (9.73-13.64)	0.3022	1.20 (0.95-1.52)	1.16 (0.97-1.38)
Public service	68.31 (66.88-69.73)	65.51 (61.64-69.39)	65.71 (62.96-68.46)	0.3284	0.95 (0.90-1.02)	0.96 (0.92-1.01)
Home emergency	4.59 (4.36-4.81)	2.98 (2.48-3.48)	4.71 (4.24-5.18)	< 0.0001	0.65 (0.55-0.78)	1.02 (0.91-1.14)
Ambulance use	56.61 (54.20-59.03)	63.04 (55.59-70.50)	44.15 (39.42-48.87)	< 0.0001	1.11 (0.98-1.25)	0.79 (0.71-0.89)
SUS	75.37 (73.23-77.51)	82.46 (76.98-87.93)	80.23 (76.24-84.23)	0.0953	1.09 (1.01-1.17)	1.06 (1.00-1.12)
Health plan	13.52 (11.88-15.16)	12.44 (7.69-17.18)	14.75 (10.92-18.58)	0.6309	0.94 (0.63-1.41)	1.10 (0.83-1.45)
Paid some amount	7.26 (6.14-8.37)	2.44 (0.65-4.22)	7.40 (4.99-9.8)	0.0043	0.33 (0.16-0.68)	1.06 (0.75-1.51)

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[1] Collaborations

All four authors TC Simões, KC Meira, J Santos and DCP Câmara contributed at all points: conception and design or data analysis and interpretation; writing of the paper or its critical review; and approval of the version to be published.