Oliveira Bruno Luciano Carneiro Alves de, Cardoso Luís Felipe Castro, Dominice Rayssa de Oliveira, Corrêa Alessa Arruda Pinto, Fonseca Ana Eliza de Carvalho, Moreira Jessica Pronestino de Lima, Luiz Ronir Raggio
Universidade Federal do Maranhão - Pinheiro (MA), Brasil.
Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil.
Rev Bras Epidemiol. 2020 Feb 21;23:e200006. doi: 10.1590/1980-549720200006. eCollection 2020.
Systemic arterial hypertension (SAH) has a high prevalence in Brazil and impacts on the use of health services.
This study verified the influence of the Family Health Strategy (FHS) on the use of health services by adults ≥ 18 years old who reported SAH in the National Health Survey (Pesquisa Nacional de Saúde - PNS) 2013.
The Propensity Score (PS) method was used to correct the lack of homogeneity between the groups with SAH under exposed or not to the FHS. PS was estimated using binary logistic regression, which reflected the conditional probability of receiving the household register in the FHS according to socioeconomic, demographic and health covariates of adults and their families. After estimating the PS, the stratification was used to group hypertensive adults into five mutually exclusive strata (pairing them). Prevalence and confidence intervals at 95% were estimated of medical consultations and hospitalizations. The effects of the complex NHS sampling were incorporated into all phases of the analysis.
It was verified that hypertensive adults enrolled in FHS had worse socioeconomic, health and health conditions, but similar prevalence of medical consultations and hospitalizations to adults without a FHS registry and with better living and health conditions. The FHS has attenuated individual and contextual inequalities that impact the health of Brazilians by favoring the use of health services.
The FHS can favor the care and control of SAH in Brazil. Thus, it must receive investments that guarantee its effectiveness.
系统性动脉高血压(SAH)在巴西的患病率很高,并对卫生服务的使用产生影响。
本研究验证了家庭健康战略(FHS)对2013年全国健康调查(Pesquisa Nacional de Saúde - PNS)中报告患有SAH的18岁及以上成年人使用卫生服务的影响。
采用倾向得分(PS)方法来纠正暴露于或未暴露于FHS的SAH组之间缺乏同质性的问题。使用二元逻辑回归估计PS,其反映了根据成年人及其家庭的社会经济、人口统计学和健康协变量在FHS中登记入户的条件概率。估计PS后,采用分层法将高血压成年人分为五个相互排斥的层次(进行配对)。估计了医疗咨询和住院的患病率及95%置信区间。分析的所有阶段都纳入了复杂的国民健康服务抽样的影响。
经证实,登记参加FHS的高血压成年人的社会经济、健康状况较差,但与未登记FHS且生活和健康状况较好的成年人相比,医疗咨询和住院的患病率相似。FHS通过促进卫生服务的使用,减轻了影响巴西人健康的个人和背景不平等。
FHS可以促进巴西SAH的护理和控制。因此,它必须获得保证其有效性的投资。