Basic sanitation and self-reported health in Brazilian capitals: a multilevel analysis

Massa, Kaio Henrique Correa; Chiavegatto Filho, Alexandre Dias Porto

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 23 • 2020 • https://doi.org/10.1590/1980-549720200050 copy

Basic sanitation and self-reported health in Brazilian capitals: a multilevel analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

This study aimed to analyze the association between the contextual determinants related to basic sanitation and self-reported health in Brazilian capitals.

Methods:

The sample consisted of 27,017 adults (≥18 years) residing in the 27 Brazilian capitals in 2013, from the National Health Survey (PNS). The association between self-reported health and sanitation (sewage system, water supply and garbage collection) was analyzed using Bayesian multilevel models, controlling for individual factors (first level of the model) and area-level socioeconomic characteristics (second level).

Results:

We found a consistent association between better self-reported health and better sanitation levels, even after controlling for individual and contextual characteristics. At the contextual level, lower odds of poor self-reported health was observed among those living in areas with medium (OR = 0.59, 95%CI 0.57 - 0.61) or high (OR = 0.61, 95%CI 0.57 - 0.66) sewage system level; medium (OR = 0.77, 95%CI 0.71 - 0.83) coverage of water supply; and high (OR = 0.78, 95%CI 0.69 - 0.89) garbage collection level.

Conclusion:

The positive association between better sanitation conditions and health, independently of the individual factors and the socioeconomic characteristics of the place of residence, confirms the need to consider sanitation in the planning of health policies.

Keywords:
Basic Sanitation; Health; Water Supply; Sewage; Solid Waste Collection

Characteristics	Total		Poor health rating		p^b
Characteristics	n*	%^a	n*	%^a	p^b
Total	27.017	100	1.367	4.54
Sex
Male	11.091	45.05	428	3.61	0.000
Female	15.926	54.95	939	5.30	0.000
Age (years)
18-24	3.513	15.39	58	1.79	0.000
25-39	9.440	32.61	222	2.26
40-59	9.152	33.96	569	5.47
60 or +	4.912	18.04	518	9.25
Race/skin color
While	11.202	47.21	467	3.67	0.001
Brown	12.650	40.80	689	5.09
Black	2.704	9.96	179	5.48
Other	459	2.04	32	9.03
Schooling
Fundamental not completed	6.052	24.10	593	9.54	0.000
Fundamental completed	3.504	15.37	161	3.77
Secondary completed	8.553	38.68	265	3.19
Higher education completed	4.733	21.84	91	1.70
Lives with partner
No	12.694	44.07	737	4.89	0.097
Yes	14.323	55.93	630	4.26	0.097
Smoking
Never smoked	19.212	70.82	796	3.94	0.000
Used to smoke	4.347	16.48	348	6.48
Currently smokes	3.458	12.70	223	5.38

Region	Capital	Sewage system			Water supply		Solid waste collection
Region	Capital	%	Tertile	%	Tertile	%	Tertile
North	Porto Velho	42.82	B	37.73	B	89.51	B
	Rio Branco	56.69	B	52.74	B	92.50	B
	Manaus	62.35	B	76.03	B	97.91	M
	Boa Vista	54.05	B	95.95	M	96.16	B
	Belém	67.88	M	76.41	B	96.66	B
	Macapá	26.75	B	55.70	B	95.42	B
	Palmas	67.58	M	95.18	M	96.66	B
Northeast	São Luís	65.42	B	76.58	B	90.89	B
	Teresina	61.56	B	93.47	M	92.81	B
	Fortaleza	73.98	M	93.41	M	98.66	M
	Natal	61.81	B	98.42	A	98.85	M
	João Pessoa	70.82	M	96.66	M	99.14	M
	Recife	69.23	M	87.33	B	97.74	M
	Maceió	47.06	B	74.27	B	97.38	M
	Aracaju	87.17	M	97.90	M	98.97	M
	Salvador	92.82	A	98.91	A	96.53	B
Southeast	Belo Horizonte	96.20	A	99.71	A	99.44	A
	Vitória	98.07	A	99.26	A	99.76	A
	Rio de Janeiro	94.37	A	98.32	M	99.16	M
	São Paulo	92.60	A	98.96	A	99.75	A
South	Curitiba	96.34	A	99.16	A	99.90	A
	Florianópolis	87.78	M	93.15	M	99.80	A
	Porto Alegre	93.00	A	99.27	A	99.65	A
Central-West	Campo Grande	58.73	B	90.35	B	98.90	M
	Cuiabá	80.21	M	93.98	M	96.74	B
	Goiânia	76.05	M	92.45	B	99.80	A
	Brasília	87.87	M	94.81	M	97.65	M

	Empty model (n = 27,017)		Model 1 (n = 22,840)		Model 2 (n = 22,840)		Model 3 (n = 22,840)		Model 4 (n = 22,840)
1st level	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI
Intercept	0.06**	0.05 - 0.06	0.03	0.02 - 0.04	0.03	0.02 - 0.04	0.03	0.02 - 0.05	0.03	0.02 - 0.04
Sex
Female			1.50**	1.23 - 1.84	1.50**	1.23 - 1.84	1.50**	1.23 - 1.84	1.50**	1.22 - 1.84
Age (years)
25-39			1.41	0.86 - 2.29	1.41	0.86 - 2.29	1.41	0.87 - 2.30	1.40	0.87 - 2.27
40-59			2.98**	2.05 - 4.33	2.98**	2.06 - 4.33	2.99**	2.07 - 4.34	2.97**	2.07 - 4.27
60 or +			4.06**	2.84 - 5.79	4.06**	2.85 - 5.77	4.07**	2.85 - 5.81	4.03**	2.86 - 5.69
Race/skin color
Brown			1.22	0.92 - 1.62	1.25	0.93 - 1.67	1.25	0.94 - 1.66	1.24	0.91 - 1.67
Black			1.04	0.77 - 1.41	1.08	0.79 - 1.47	1.08	0.78 - 1.51	1.04	0.77 - 1.42
Other			2.76*	1.09 - 6.95	2.78*	1.11 - 6.96	2.82*	1.13 - 7.03	2.76*	1.08 - 6.98
Schooling
Fundamental completed			0.48**	0.42 - 0.55	0.48**	0.42 - 0.55	0.48**	0.42 - 0.56	0.48**	0.42 - 0.56
Secondary completed			0.43**	0.36 - 0.51	0.43**	0.36 - 0.51	0.43**	0.36 - 0.51	0.43**	0.36 - 0.51
Higher education completed			0.20**	0.16 - 0.23	0.20**	0.16 - 0.23	0.20**	0.16 - 0.26	0.20**	0.16 - 0.26
Lives with partner
Yes			0.82**	0.73 - 0.91	0.82**	0.73 - 0.91	0.82**	0.73 - 0.91	0.82**	0.73 - 0.91
Smoking
Used to smoke			1.14	0.79 - 1.65	1.13	0.78 - 1.64	1.13	0.78 - 1.64	1.14	0.79 - 1.65
Currently smokes			1.19	0.91 - 1.56	1.18	0.90 - 1.54	1.18	0.90 - 1.56	1.18	0.90 - 1.55
2nd level: Capital
Sewage system, tertile
Middle					0.50^**	0.46 - 0.53
Upper					0.83^**	0.75 - 0.92
Water supply, tertile
Middle							0.88^*	0.81 - 0.96
Upper							0.91	0.83 - 1.01
Solid waste collection, tertile
Middle									0.83^**	0.75 - 0.91
Upper									0.82^*	0.72 - 0.93
BIC (ICC)	13,224.534	(0.007)	10,254.007	(0.012)	10,253.238	(0.025)	10,255.672	(0.018)	10,253.724	(0.016)

	Model 1 (n = 22.840)		Model 2 (n = 22.840)		Model 3 (n = 22.840)
1st level	OR	95%CI	OR	95%CI	OR	95%CI
Intercept	0.03**	0.02 - 0.05	0.03**	0.02 - 0.05	0.03**	0.02 - 0.04
2nd level: Capital
Sewage system, tertile
Middle	0.59**	0.57 - 0.61
Upper	0.61**	0.57 - 0.66
Water supply, tertile
Middle			0.77**	0.71 - 0.83
Upper			0.97	0.87 - 1.07
Solid waste collection, tertile
Middle					0.93	0.83 - 1.05
Upper					0.78**	0.69 - 0.89
Income per capita, tertile
Middle	1.05*	1.01 - 1.10	0.92	0.84 - 1.01	1.73**	1.53 - 1.97
Upper	1.14*	1.06 - 1.22	0.89*	0.81 - 0.98	0.89	0.76 - 1.05
BIC (ICC)	10,250.792	(0.016)	10,253.789	(0.038)	10,258.198	(0.058)

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E-mail: revbrepi@usp.br

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[1] Corresponding author: Kaio Henrique Correa Massa. Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo. Avenida Dr. Arnaldo, 715, Cerqueira César, CEP: 01246-904, São Paulo, SP, Brazil. E-mail: kaiomassa@usp.br