Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil.
Am J Public Health. 2021 May;111(5):927-936. doi: 10.2105/AJPH.2020.306146. Epub 2021 Mar 18.
To investigate the role of the Family Health Strategy (FHS) in reducing social inequalities in mortality over a 9-year follow-up period. We carried out a population-based cohort study of individuals aged 60 years and older from the city of Bagé, Brazil. Of 1593 participants at baseline (2008), 1314 (82.5%) were included in this 9-year follow-up (2017). We assessed type of primary health care (PHC) coverage and other variables at baseline. In 2017, we ascertained 579 deaths through mortality registers. Hazard ratios and their 95% confidence intervals modeled time to death estimated by Cox regression. We also tested the effect modification between PHC and wealth. The FHS had a protective effect on mortality among individuals aged 60 to 64 years, a result not found among those not covered by the FHS. Interaction analysis showed that the FHS modified the effect of wealth on mortality. The FHS protected the poorest from all-cause mortality (hazard ratio [HR] = 0.59; 95% confidence interval [CI] = 0.36, 0.96) and avoidable mortality (HR = 0.46; 95% CI = 0.25, 0.85). FHS coverage reduced social inequalities in mortality among older adults. Our findings highlight the need to guarantee universal health coverage in Brazil by expanding and strengthening the FHS to promote health equity.
为了探究家庭健康策略（FHS）在 9 年随访期间对降低死亡率社会不平等的作用。我们开展了一项基于人群的队列研究，对象为巴西巴伊亚市年龄在 60 岁及以上的个体。在 1593 名基线参与者（2008 年）中，有 1314 名（82.5%）纳入了这项 9 年随访（2017 年）。我们在基线评估了初级卫生保健（PHC）的覆盖类型和其他变量。2017 年，我们通过死亡率登记册确定了 579 例死亡。用 Cox 回归估计死亡时间，计算风险比及其 95%置信区间。我们还检验了 PHC 和财富之间的效应修饰作用。FHS 对 60-64 岁人群的死亡率有保护作用，但 FHS 未覆盖人群中未发现这种作用。交互分析表明，FHS 改变了财富对死亡率的影响。FHS 使最贫困人群免受全因死亡率（风险比[HR] = 0.59；95%置信区间[CI] = 0.36，0.96）和可避免死亡率（HR = 0.46；95% CI = 0.25，0.85）的影响。FHS 的覆盖范围降低了老年人死亡率的社会不平等。我们的研究结果强调了在巴西通过扩大和加强 FHS 来保证全民健康覆盖以促进健康公平的必要性。
