Oliveira Elaine Cristina Tôrres, Louvison Marília Cristina Prado, Duarte Yeda Aparecida de Oliveira, de Andrade Fabíola Bof
Faculty of Public Health, University of São Paulo (USP), São Paulo, São Paulo, Brazil.
State University of Health Sciences of Alagoas, Maceió, Alagoas, Brazil.
PLoS One. 2025 May 28;20(5):e0322333. doi: 10.1371/journal.pone.0322333. eCollection 2025.
Analysis of trends and the magnitude of inequalities in access to health services contributes to identifying privileged groups and facilitates discussions on equity policies. Brazil has an important context for studying healthcare access inequalities due to its rapid population aging and the existence of a universal healthcare system guided by equity principles. Therefore, this study aimed to assess socioeconomic inequalities in the prevalence of difficulties accessing healthcare services among older adults living in the city of São Paulo, Brazil. This cross-sectional study used data from the Health, Well-being, and Aging Study from three years: 2006 (n = 1,386), 2010 (n = 1,319), and 2015 (n = 1,218). The dependent variable used in this study was difficulty accessing healthcare services, an outcome that aimed to assess, based on the perception of access barriers, any difficulty in using or accessing healthcare services when needed. Independent variables were socioeconomic position measured by years of education (which reflects the number of years of education completed) and monthly income (measured in minimum wages). Absolute (SII) and relative (RII) inequality indices were employed to assess the magnitude of socioeconomic inequalities. The findings indicate that individuals with higher socioeconomic status (measured by education and income) experienced lower frequencies of difficulty in accessing healthcare services. Absolute inequalities based on education and income were significant in 2006 [SII:-0.328 (-0.437; -0.220) and SII:-0.191 (-0.295; -0.087), respectively] and 2015 [SII = -0.198 (-0.314; -0.082) and SII = -0.313 (-0.425; -0.201), respectively]. Relative inequalities were significant across all study years, with difficulties in access being 68.0%, 17.0%, and 42.0% lower among individuals with higher education, and 49.0%, 22.0%, and 58.0% lower among those with higher income in 2006, 2010, and 2015, respectively. This study showed that difficulties to access were more concentrated among individuals with lower socioeconomic status, emphasizing the importance of true universalization of the healthcare system to ensure equitable access.
分析获得卫生服务的趋势和不平等程度，有助于识别特权群体，并促进关于公平政策的讨论。由于巴西人口迅速老龄化，且存在以公平原则为指导的全民医疗体系，该国为研究医疗服务可及性不平等提供了重要背景。因此，本研究旨在评估巴西圣保罗市老年人在获得医疗服务方面存在困难的患病率的社会经济不平等情况。这项横断面研究使用了来自健康、福祉与老龄化研究三年的数据：2006年（n = 1386）、2010年（n = 1319）和2015年（n = 1218）。本研究中使用的因变量是获得医疗服务的困难程度，该结果旨在根据对获取障碍的认知，评估在需要时使用或获得医疗服务时是否存在任何困难。自变量是通过受教育年限（反映完成的教育年限）和月收入（以最低工资衡量）来衡量的社会经济地位。采用绝对（SII）和相对（RII）不平等指数来评估社会经济不平等的程度。研究结果表明，社会经济地位较高（以教育和收入衡量）的个体在获得医疗服务方面遇到困难的频率较低。基于教育和收入的绝对不平等在2006年[分别为SII：-0.328（-0.437；-0.220）和SII：-0.191（-0.295；-0.087）]和2015年[分别为SII = -0.198（-0.314；-0.082）和SII = -0.313（-0.425；-0.201）]时具有显著性。相对不平等在所有研究年份均具有显著性，2006年、2010年和2015年，受过高等教育的个体获得医疗服务的困难程度分别低68.0%、17.0%和42.0%，收入较高的个体分别低49.0%、22.0%和58.0%。本研究表明，获得医疗服务的困难更多地集中在社会经济地位较低的个体中，这凸显了医疗体系真正普及以确保公平可及性的重要性。
