El lugar donde se vive y la autopercepción de la salud en un gran centro urbano

Rodrigues, Daiana Elias; César, Cibele Comini; Xavier, César Coelho; Caiaffa, Waleska Teixeira; Proietti, Fernando Augusto

doi:10.1590/0102-311X00166714

Brasil

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ARTICLE • Cad. Saúde Pública 31 (suppl 1) • Nov 2015 • https://doi.org/10.1590/0102-311X00166714 linkcopiar

El lugar donde se vive y la autopercepción de la salud en un gran centro urbano

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

El objetivo de este estudio fue determinar la relación entre la percepción del lugar de residencia y la autopercepción de la salud. La información se obtuvo a través de entrevistas a 4.048 adultos que viven en Belo Horizonte, Minas Gerais, Brasil, entre 2008 y 2009. Para evaluar la asociación se utilizó la regresión logística ordinal. La autopercepción de la salud fue reportada como buena/muy buena, regular y mala/muy mala, respectivamente, por el 65,7%, 27,8% y 6,5% de los participantes. Una mejor autopercepción de la salud se asoció con los siguientes aspectos del vecindario: la evaluación positiva de la estética y de la movilidad, la mejora de la calidad de los servicios locales, menos desorden físico y social. La percepción local de violencia mostró asociación estadística marginal con una mala autopercepción de salud. Los resultados mantuvieron el control de posibles variables de confusión demográficas, socioeconómicas, condiciones y conductas de salud. Los resultados indican que las políticas públicas y de salud deben incorporar intervenciones sobre el entorno físico y social, además de sobre las políticas de corte individual.

Autoevaluación; Estado de Salud; Percepción Espacial; Salud Urbana

Variables	n (%)	Self-rated health [n (%)]
Variables	n (%)	Very good/Good	Fair	Poor/Very poor
Age (years) *	44.4 (17.0)	41 (16.2)	50 (16.7)	54.4 (15.6)
Sex
Male	1,659 (41.0)	1,144 (69,0)	430 (25.9)	85 (5.1)
Female	2,389 (59.0)	1,513 (63.4)	693 (29)	181 (7.6)
Marital status
Single	1,214 (30.0)	913 (75.2)	253 (20.9)	47 (3.9)
Married, living together	2,155 (53.2)	1,397 (64.9)	616 (28.6)	141 (6.5)
Divorced, separated	333 (8.2)	192 (57.7)	108 (32.4)	33 (9.9)
Widow(er)	346 (8.6)	155 (44.8)	146 (42.2)	45 (13.0)
Schooling
No schooling	105 (2.6)	40 (38.1)	37 (35.2)	28 (26.7)
Able to read, primary school equivalency, 1^st-4^th grades not completed	543 (13.5)	248 (45.7)	226 (41.6)	69 (12.7)
1st-4th grade completed, 5th-8th grade not completed	982 (24.2)	540 (55.0)	358 (36.5)	83 (8.5)
5th-8th grade completed, high school not completed	632 (15.7)	442 (70.0)	158 (25.0)	31 (5.0)
High school graduate, technical school, attended university	1,341 (33.1)	1,022 (76.2)	275 (20.5)	44 (3.3)
University graduate, post-undergraduate studies	443 (1.9)	363 (81.9)	69 (15.6)	11 (2.5)
Chroic illness
None	1,498 (37.5)	1,287 (85.9)	196 (13.1)	15 (1.0)
1-3	2,043 (51.0)	1,248 (61.1)	681 (33.4)	113 (5.5)
3 or more	460 (11.5)	101 (22.0)	229 (49.8)	130 (28.2)
Disabilities
No	3,546 (87.6)	2,474 (69.8)	909 (25.6)	162 (4.6)
Yes	502 (12.4)	183 (36.5)	214 (42.7)	104 (20.8)
Has private health insurance
Yes	1,753 (43.3)	1,260 (71.9)	409 (23.3)	83 (4.8)
No	2,292 (56.7)	1,394 (60.9)	714 (31.1)	183 (8.0)
Smoking
Current smoker	736 (18.2)	439 (59.7)	236 (32.0)	61 (8.3)
Former smoker	976 (24.1)	588 (60.4)	308 (31.6)	78 (8.0)
Never smoked	2,336 (57.7)	1,630 (69.8)	579 (24.8)	127 (5.4)
Consumes fruits and vegetables
≥ 5 times/week	2,178 (53.8)	1,167 (62.5)	573 (30.7)	128 (6.8)
< 5times/week	1,870 (46.2)	1,490 (68.4)	550 (25.2)	138 (6.3)
Body mass index (kg/m²) *	26 (5.0)	25.4 (4.8)	27 (5.3)	28.5 (5.9)
Socioeconomic position (score) **
1	808 (100)	443 (54.8)	290 (35.9)	75 (9.3)
2	818 (100)	92 (60.2)	260 (31.8)	66 (8.0)
3	784 (100)	498 (63.5)	232 (29.6)	54 (6.9)
4	804 (100)	573 (71.3)	190 (23.7)	41 (5.0)
5	803 (100)	637 (79.3)	140 (17.4)	26 (3.2)
Years residing in household (years) ***	13 (4-24)	12 (4-23)	15 (5-27)	18 (6-30)
Perception of the neighborhood scales ^#
Aesthetic quality	1.3 (0.66)	1.3 (0.65)	1.2 (0.66)	1.0 (0.70)
Mobility	2.0 (0.46)	2.0 (0.45)	1.9 (0.47)	1.8 (0.53)
Quality of services	1.7 (0.67)	1.8(0.66)	1.7 (0.68)	1.6 (0.72)
Violence	1.7 (0.67)	1.7 (0.66)	1.6 (0.69)	1.5 (0.64)
Physical disorder	1.8 (0.70)	1.8 (0.69)	1.8 (0.71)	1.7 (0.70)
Social disorder	1.0 (0.71)	1.0 (0.71)	0.9 (0.72)	0.9 (0.69)

Scales	n	Highest score	Mean score	Standard deviation
Aesthetic quality	3,922	1.92	1.26	0.66
Mobility	3,802	2.53	1.99	0.46
Quality of services	3,647	2.81	1.76	0.67
Violence	3,932	2.44	1.70	0.67
Physical disorder	3,845	2.78	1.85	0.70
Social disorder	3,655	1.99	1.00	0.72

Variables	OR	95%CI
Age (years)	1.03	1.03-1.04
Sex
Male	1.00
Female	1.38	1.16-1.64
Marital status
Single	1.00
Married, living together	1.86	1.50-2.31
Divorced, separated	2.21	1.57-3.11
Widow(er)	4.81	3.37-6.89
Schooling
No schooling	1.00
Able to read, primary school equivalency, 1^st-4^th grades not completed	0.52	0.29-0.93
1st-4th grade completed, 5th-8th grade not completed	0.34	0.19-0.60
5th-8th grade completed, high school not completed	0.17	0.09-0.30
High school graduate, technical school, attended university	0.13	0.07-0.24
University graduate, post-undergraduate studies	0.08	0.04-0.15
Chroic illness
None	1.00
1-3	3.80	3.05-4.73
3 or more	19.6	14.01-27.4
Disabilities
No	1.00
Yes	4.92	3.90-6.20
Has private health insurance
Yes	1.00
No	1.60	1.35-1.90
Smoking
Current smoker	1.00
Former smoker	0.94	0.70-1.24
Never smoked	0.59	0.46-0.74
Consumes fruits and vegetables
≥ 5 times/week	1.00
< 5times/week	0.71	0.60-0.85
Body mass index (kg/m²)	1.03	1.03-1.04
Socioeconomic position (score)	1.07	1.05-1.10
1
2	1.00
3	0.81	0.66-0.98
4	0.70	0.57-0.85
5	0.49	0.40-0.60
Years residing in household (years)	0.31	0.25-0.39
Perception of the neighborhood scales **	1.01	1.00-1.02
Aesthetic quality
Mobility	0.84	0.72-0.97
Quality of services	0.72	0.59-0.88
Violence	0.89	0.77-1.01
Physical disorder	0.87	0.77-0.99
Social disorder	0.94	0.83-1.06
Sex	0.86	0.75-0.97

Scales	OR	95%CI
Aesthetic quality	0.80	0.68-0.94
Mobility	0.78	0.64-0.96
Quality of services	0.84	0.71-0.98
Violence	0.86	0.74-1.00
Physical disorder	0.83	0.72-0.96
Social disorder	0.85	0.74-0.98

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[TFN1] * Mean and standard deviation; ** Score range between 0 and 3.39: higher number of assets = higher score; *** Median, Q1 and Q3; ^# Score range between 0 – 2.81: better perception of neighborhood = higher score. The variable Quality of services had the most missing data: n = 401 (9.9%).