Associação entre fatores contextuais e auto-avaliação de saúde: uma revisão sistemática de estudos multinível

Abstract

The influence of residential characteristics on self-rated health has received little research attention, especially in Brazil. This study summarizes the available evidence on the association between contextual factors and self-rated health, using a systematic review of articles published from January 1995 to August 2005. We searched for the terms neighbourhood or neighborhood, ecological, contextual, environment, and community, combined with self-rated health, selfreported health, and multilevel IntroduçãoA influência de características individuais e contextuais do local de moradia (vizinhança) na auto-avaliação de saúde ainda é um tema pouco estudado, especialmente no Brasil.A auto-avaliação de saúde é um indicador cada vez mais utilizado em pesquisas epidemiológicas. Diversas investigações apontam que a percepção da saúde prediz, consistentemente, a mortalidade e o declínio funcional em idosos 1 . De fato, a auto-avaliação de saúde tem se revelado melhor preditor de mortalidade do que diversas medidas objetivas do estado de saúde 1 , refletindo a percepção integrada do indivíduo que inclui as dimensões biológica, psicológica e social da saúde 2 .Um grande conjunto de características individuais que influenciam desfechos de saúde já foi bem estabelecido. Fatores sócio-econômi-cos como educação, renda, desemprego, hábitos de vida são determinantes conhecidos da saú-de individual 3 e, em particular, da auto-avaliação da saúde 4,5,6 . Dentre os determinantes da auto-avaliação de saúde, destaca-se a posição sócio-econômica individual, essa associação tem sido amplamente demonstrada em diversos estudos 7,8,9,10 . Na última década, muitas áreas de investigação em ciências sociais e epidemiologia têm buscado refinar a pesquisa sobre as relações entre indivíduos e o contexto em que vivem. Há muitas REVISÃO REVIEW

Self-rated health in urban adults, perceptions of the physical and social environment, and reported comorbidities: The BH Health Study

“…Even after adjustment, the association between poor self-rated health and variables from the neighborhood environment confirm previous results 14,27 , thus reinforcing the importance of incorporating factors from the living environment into self-rated health, based on the presence of diseases in population studies 16 .…”

“…However, future studies should consider the use of multilevel analyses capable of dealing with the effects of possible clusters among the characteristics of individuals and their contexts, leading to a more refined measurement of the contribution by each level (individual and contextual) to the determinants of self-rated health 14 .…”

“…A growing number of studies incorporate environmental characteristics as determinants of self-rated health (although fewer in number and with less intensity when compared to those contemplating individual characteristics) 14 . Two pillars of urban health assist the understanding of the environment's influence on self-rated health: the role of the physical and social setting in shaping individual health and the need to measure phenomena involving unjust and avoidable inequalities in the environment and in health 15 .…”

Is cognitive decline in the elderly associated with contextual income? Results of a population-based study in southern Brazil

“…In Brazil, some studies that used the income variable to characterize the context have shown that lower average income and greater concentration of wealth in the neighborhood are associated with some health outcomes such as poor health self-assessment 19 , greater prevalence of functional disabilities 20 , and higher systolic blood pressure 21 . However, as of September 2015, no study published in Brazil has been found with the aim of investigating the association between income and contextual cognitive decline.…”

Adaptacao transcultural e confiabilidade de medidas de caracteristicas autorreferidas de vizinhanca no ELSA-Brasil

“…26 Secondary databases have comprised the main source of contextual information in recent studies. However, individuals' responses (primary data) to relevant questions about processes that occur in the neighborhood and also the defi nitions of measurements inherent to the contextual level 9,19 (e.g., the defi nition of "neighborhood" itself) still form gaps in the knowledge of this fi eld.…”